LESS TUBERCULOSIS

Northern Advocate, 5 July 1928, Page 8

LESS TUBERCULOSIS

j THE DECLINE IN BRITAIN I MORE HYGIENIC LIVING Observations on the decline in tuberculosis mortality in the British Isles and elsewhere were made in a recent address by the president of the British Medical Association, Sir Robert Philip, professor of tuberculosis at the University of Edinburgh. He said the decline must be largely due to the increasing practice by the population of hygienic modes of living and by the spread and use of knowledge concerning’ the disease. He asserted, however, that where systematic work against the disease was not pursued, little improvement was to be exIpected. [ Sir Robert showed that whereas in j the five years 1869-73 the mean death- | rate in England and Wales was 2210 I per 100,000 of population, and the rate I for all tuberculosis was 306 and for pulmonary tuberculosis 232, the corresponding rates for the period 191923 were respectively 1246, 114 and 89. The decrease in the interim had been virtually unbroken. The rates for Scotland and Ireland in the same period, although higher throughout, showed similar steady decreases. Pie pointed out that not only was the absolute fall in tuberculosis mortality greater, but the rate of fall showed a steady acceleration. Whereas all tubei'culosis accounted for 13.9 per cent of the deaths in England and Wales from all causes in 1869-73, and pulmonary tuberculosis for 10.5 per cent, the proportions in 1919-23 were 9.1 and 7.1 per cent respectively. DECREASE SINCE THE WAR To show the value of systematic anti-tuberculosis work, Sir Robert quoted figures relating to the admin isti’ative county of Lancaster, with a population of 2,000,000, where a most comprehensive scheme, with full-time officers, is in operation. In the prewar years 1905-14, the death-rate from pulmonary tuberculosis showed variations, but little general decline, averaging 86 per 100,000 of population. In the post-war years 1919-27 it declined steadily from 80 to 61, the average being 70. In Paris prior to the war the rate was about 400 per 100,000, but later the authorties began an anti-tuberculosis movement, and in 1921 the rate had fallen to 286.

“Enough has been Cited,” said Sir Robert, “to support the view that where special anti-tuberculosis work is undertaken results follow, and that conversely, in proportion as a laissezfaire policy is pursued, little happens.”

' i The tenor of the address is best ini j terpreted by quotations from an editorial in the “British Medical Journal”: “The anti-tuberculosis campaign . which developed in this country soon ; after 1911,” it says, “was inspired in great measure by the linked dispen- . sary and sanatorium system which Sir Robert Philip had established in the city of Edinburgh. BETTER LIVING CONDITIONS “Recognising that the downward course of the tuberculosis death-rate had begun long before any formal j anti-tuberculosis regime had been inj stituted, he seeks his solution in those j causes which began to operate as a | result of the movement which followed the Royal Commission of 1869. An awakened interest in sanitary matters, an improvement in the educational standards of the people, a diffusion of general and special knowledge among clashes previously excluded, betterment of housing and working conditions, higher wages, shorter hours, better feeding, the open-air life—all these contributory factors have, in his view, increased communal vitality and tended to curb the ravages of the disease. “It is probable, too, that many of these contributory factors have acted also in a direct manner by cutting across the path of infection and reducing the frequency of the opportunities for the transmission of the virus to children at young ages. The j path of infection between bovine animals and man is closed, as a result of recent milk legislation, by the sale of j milk from tuberculin-tested herds, and by the Tuberculosis Order, of 1925. “But these specific factors, valuable j as they were, were preceded, and are j still being reinforced, by that group j of causes which, taken together, make j up what is known as social uplift. The j tuberculosis infection is followed back { into the homes of the people; early j associated cases are discovered and put on treatment; the pre-tuberculous | are shepherded along the paths which j lead to health; defective environmen- j tal conditions are rectified; and an; unobtrusive, but potept, anti-tubercu- j losis propaganda is set on foot, pre- j cisely in the places and among the j people by whom it is most required.” -