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33
Special Measures.
The special feature of pulmonary tuberculosis which makes its
control and eradication so difficult is the insidiousness of its onset.
When the disease is recognised the patient on looking back can then
realise the significance of those ignored symptoms present probably for
many months. In the meantime the unrecognised patient may be a
source of infection to others, while the advancing state of the lesion
necessitates long period treatment to effect cure even in those cases where
the time for cure has not, as it so often has by this time, actually passed.
Though not invariably so, diagnosis can usually be made earlier by
X-rays than by physical examination. The introduction then of arrangements
by which large bodies of normal population can be examined by
mass radiography gives hope for the early recognition of the disease.
Mass radiography is not sufficient by itself, but it can separate from the
apparently normal population those requiring further individual diagnosis
by established methods. It will be a long time before these facilities
can be offered to the entire community, but it is desirable that at least
those who are special risks, either because of their age or because of the
nature of their occupation, should be offered these benefits, though again
their usefulness may be limited because the disease is so rapidly established
in adolescents and in young adults. Early recognition of the
disease is of advantage to the patient by enabling him to obtain treatment
while the disease is in the curable stage; no less advantageous is it to the
community if it results in the removal from its midst of open infectious
cases.
The poor suffer from tuberculosis and the tuberculous become poor.
Much of the work in treating tuberculous patients is very soon nullified
because the wage-earner cannot afford to remain in the sanatorium
sufficiently long for his lesion to be fully arrested, or because on leaving
he must return to those conditions at home or at work which led to the
breakdown in his resistance and so to the onset of the declared disease.
Under the new arrangements a person who can be cured—and as these
arrangements made under the Defence of the Realm Regulations are
primarily in the interests of the manpower situation of the country, the
scheme applies only to those who are likely to become fit—whether in an
institution or not, can receive a maintenance allowance while he is unfit
for any work, and also assistance during the period of restoration to full
working capacity. Perhaps some similar measure can be introduced for
the benefit of all affected, regardless of their working capacity.
The incidence of tuberculosis has for years been steadily declining
though the fall was interrupted by the 1914-18 war and again by this.
It can be expected that early diagnosis and removal from the community
by speedy admission of diagnosed cases to sanatoria will lead to a fall to
still lower levels. It is, perhaps, too much to hope for the complete
eradication of the disease, so there will occur in most a reaction of the
individual to invasion by the organism, a reaction though which, as in
the case of most of us today, does not result in disease. Not so very long
ago typhoid fever was not uncommon in this country, outbreaks occurring
particularly in the autumn. When a disease is very prevalent it may be
difficult to trace the source of infection. Today typhoid fever is relatively