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72
A general decline in mortality from pulmonary tuberculosis
began in this country from the middle of the last century and continued
in the early part of this century. A marked check occurred
during the Great War, but following the war a decline again occurred,
but recently a check in the improvement has occurred. The recent
check in the mortality from pulmonary tuberculosis has occurred
during a period when interest in matters of public health in general
has been greater than ever. This check has taken place as a result
of factors other than failure to utilise the special arrangements
for the treatment of the disease. The decline in the mortality from
pulmonary tuberculosis began in this country before any specific
measures were taken against the disease, and was accompanied
by a substantial decline in the mortality from all other diseases
taken together.
The early impovement was undoubtedly due to the improvement
in the general social and economic conditions of the mass of the
people. Housing, nutrition and other factors determine the general
level of social conditions. A patient of ample means returning
home from a sanatorium can afford to adjust his life until it is safe
for him to resume it under former conditions. A working-class
patient after the benefit of similar treatment returns to a home
environment where even separate sleeping accommodation is impossible.
Although the conditions would not constitute actual
overcrowding under the 1935 Housing Act, from an infection point
of view they are undesirable. Frequently we have requests from
a family, one of whose members has been to a sanatorium, sometimes
supplemented by a letter from a Tuberculosis Officer, for a Council
house because of the want of sufficient space at the home to admit
of separate sleeping accommodation for the patient. Supervision
of contacts is difficult because the other members of the family
are always in intimate contact with the patient. It has been suggested
that preferential housing treatment should be accorded to
pulmonary tuberculosis patients but landlords are loth to let their
houses, and even municipal housing committees are unwilling to
convert their estates into Tubercular settlements. Besides, a tubercular
patient, if he is the head of the family, is unable to afford
better accommodation. Unless he is fortunate enough to have
substantial savings, which he rarely has, the standard of living
will be substantially lower than before bis illness. These are some
of the difficulties which confront us in the fight against tuberculosis
no matter how excellent the facilities for treatment may be; not
only will they effect the results of treatment, but will militate against
early diagnosis and treatment.