LETTERS TO THE EDITOR
THE PLIGHT OF THE TUBERCULOUS
SIR,—As a physician with many years' practical experience amongst sufferers from pulmonary tuberculosis I welcome the letter from "Scottish Doctor." As a nation we are dependent for economic survival on industrial output and production, and the public should be widely conscious of the damage wrought by tuberculosis. In the age-group fifteen to fifty, yielding the vast .bulk of industrial output, tuberculosis is annually responsible for a greater mortality than that caused by any other disease. By virtue of its attack on younger age-groups this disease is the cause of an immense economic loss to the community. This recurrent loss is of still greater impart in view of a prediction by the Royal Commission on Population (1949) that the number of young adults, aged fifteen to forty, is likely to decline by 1,400,000 over the next fifteen years.
The insufficiency of nurses is a major part of the tuberculosis problem, and some thousands of beds are unoccupied from this cause alone. The shortage of nurses is not confined to tuberculosis sanatoria and will not be solved by offers of increased pay. The inducements of non-residential work in other fields will maintain this shortage in Britain. In April, 1948, the Stationery Office issued the report of the manpower conference convened by the Committee of European Economic Co-operation. The Western zones of Germany contained 500,000 women between twenty and forty-five, women who have little hope of marriage and small prospect of finding work in Germany. Today educated young women from Germany and Austria are allowed to enter Britain and undertake work in private houses as governesses and domestic helps. Why cannot the Government enrol sufficient of these women, on a voluntary basis, as nursing auxiliaries ? Sufficient volunteers could be obtained within a few months to ease an acute, and increasing, bed shortage. This has led to mountainous waiting-lists, and too much paper is chasing too few beds.
The continued presence of active infectious cases in unsuitable homes is increasing the problem two- or three-fold by the extension of disease to others who in their turn need treatment. Throughout Britain, of the thousands dying annually from pulmonary tuberculosis, half die within a year of notification (i.e., discovery), a small proportion dying un- notified. In the majority of cases diagnosis is made too late. The public should realise that the Government's mass X-ray campaign, as at present conducted, is not fulfilling the extravagant claims originally made for it. Correspondence in the Lancet, over a year ago, revealed disquiet amongst clinicians as to the present usage of mass radiology. Few general hospitals will admit a case of pulmonary tuberculosis. Consequently students and young post-graduates pass into practice with little or no knowledge of the early stages of this important disease. If adequate precautions are taken, under the supervision of experienced physicians, it is quite safe to nurse patients in tuberculosis wards in general hospitals. The importance of the disease to the community warrants the allocation of a proportion of available beds in every big general hospital. Not only would this provide additional facilities' for treatment, but it would give opportunities for undergraduate and post- graduate instruction in diagnosis, treatment and prevention.
Tuberculosis is now so much beyond control that faith is apparently to be placed in injections of B.C.G. as an immunising agent. Artificially produced immunity will certainly benefit medical students and nurses. In the general population, where facilities for isolation arc almost non- existent, such a measure will never take the place of prompt diagnosis and treatment of the early active case. At a recent conference in London, attention was drawn, by a representative from Lancashire, to the com- position of the Minister of Health's Tuberculosis Advisory Committee. Numbers of important men and women have been asked to serve, but not a single physician working in a tuberculosis clinic 1—Yours faithfully, Willesden Chest Clinic, N.W.zo. C. H. C. TOUSSAINT.
Previous page
