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Also during this period much was accomplished towards the prevention
and treatment of tuberculosis in children by the establishment
of the School Medical Service in 1907 and by the opening of
voluntary clinics for the welfare of younger children. Another
important event was the Local Government Board's Order extending
compulsory notification to all forms of tuberculosis.
The second period began with the establishment of the
Ministry of Health in 1919 and this set up a special medical department
concerned solely with tuberculosis which led to tuberculosis
schemes becoming more unified and comprehensive. At this time
also, the importance of hospital treatment in combination with
sanatorium treatment became realised; there were great improvements
in radiological apparatus and technique, and medical
knowledge generally with regard to treatment of tuberculosis was
progressing rapidly. The treatment involving collapse of the lung
was becoming popular and giving good results. Good results were
also being obtained with non-respiratory tuberculosis by the more
extensive use of pasteurised milk and modern methods of orthopaedic
treatment.
Several events of great importance have occurred since the
outbreak of World War II. Two of these occurred in 1943, the
introduction of mass miniature radiography leading to earlier
detection of the disease in many cases and the scheme of allowances
making it possible for people with the disease to give up their work
and, freed to a certain extent from financial worries, undertake
treatment much earlier than hitherto.
The use of new drugs such as streptomycin, P.A.S., and
isoniazid have proved of great value and selected groups of the
population at special risk have been given B.C.G. vaccination.
In the light of these observations let us review the trends in
notifications and death from tuberculosis in the last ten years. We
have seen that, though the deaths from tuberculosis have fallen
markedly, the notifications of the disease have remained at much
the same level. What possible explanation can be found for this
difference? There can be little doubt that, though all the factors
mentioned have played their part in the decrease in the number of
deaths, the most potent factors in the decrease are the advances in
medical and surgical treatment and, to a lesser extent, earlier
diagnosis with consequent prevention of the advanced stage of the
disease. The question with regard to notification is not so straightforward.
The exactness of the state of notification depends on
many factors and can never be completely reliable. Allowing for
these variations and despite all the preventive measures mentioned
it appears that there has been little or no real change in the number
of notifications in the past ten years. As it would be unreasonable
to suppose that the steps taken in the last 100 years have had no