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124 Auglys~R, TUBERCULOSIS and the WAR, THERE Appears To

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124 Auglys~R, TUBERCULOSIS and the WAR, THERE Appears To 124 PUBLIC HEALTH. AuGlys~r, TUBERCULOSIS AND THE WAR, The association with increased mortality BY from influenza is shown as follows :-- GEORGE JESSEL, M.A., M.D., D.P.H., 1913 ... Deaths from Influenza ... 191 Tuberculosis Officer, Lancashire Counly Council. 1914 ... ,~ ,, ,, ... 215 1915 ... , ..... -.. 324 THERE appears to be general agreement that 1916 ... , ..... ... 369 one effect of the War has been to increase It may be urged that this increased mortality the prevalence of Tuberculosis in all the belli- from Pulmonary ~i'uberculosis is more apparent gerent countries. It is probable, however, that than real, and is due to greater precisiotI ill there have been considerable variations in the diagnosis and certification. While there call extent to which this has taken place in different be no doubt that diagnosis and death certifica- lands, and even in different parts of our own tion are tending to become more accurate, country, according to the influence which the the following figures which give the Lancashire war has had upon the usual predisposing County eonfinued death rate from Bronehitis factors. In England and Wales overcrowding and Pneumonia--diseases with which Pul- has become much more marked owing to the monary Tuberculosis is frequently confused-- cessation of building, especially in areas where show that this is not the principal factor. war-work has caused an influx of population, 1913. Bronchitis and Pneumonia continued deathrate 2.53 Overwork and overstrain have been general, 1914. ,~ ,, ~, ~ ,~ ~ 2,51 due to long hours of employment, the journey I915- ,, ,, , ,~ ,~ , 3,04 to and from work, and it.may be the conditions :,)16..... ,, . ,, . 2,54 under which the work itself has been performed. It will be noticed that in 19I 5 the rate from On the other hand, there has been little poverty. Bronchitis and Pneumonia was also definitely Although successive increases of wages have increased. The influence of the weather, not kept pace with the rising prices of com- doubtless, also played no inconsiderate part modities, yet owing to the fact that pooling of in this increase. Similar figures have been households has become common and that more published by Drs. Kerr and Dickinson for members of families are now wage-earners than Neweastle-on-Tyne, and probably hold good for was formerly the case, the condition of the most large centres of population. In smaller working etasses and. especially those engaged towns the figures are less striking though upon war-work, has been hitherto prosperous. tending to support the general conclusion. If, however, the present shortage of food should Thus the following figures may be quoted for increase, it cannot but materially affeet the the County Borough of Wigan :- nutrition of the people. As regards alcohol, Number of Deaths from-- Bronchitis and the restrictions of the Central Control Board Year. P~Im. Tub. Influenza. Pneumonia. and the short supply have resulted in a very marked improvement in national sobriety. 1913 ...... 81 ...... 9 ...... 412 Sir A. Newsholme has stated that the number 1914 ...... 89 ...... 5 ...... 375 1915 ...... 95 ...... 12 ...... 419 of deaths from Pulmonary Tuberculosis in 1916 ...... 86 ...... 9 ...... 303 England and Wales showed in 1914 , 19I 5 , and Thus in 1915 the relationship between the 1916 increases of 4.12 and 12 per cent. respeet- increased mortality from Phthisis and that ively, as compared with 1913. This increased from Influenza and Bronchitis and Pneumonia mortality was shared by both sexes, and appears is shown. to have been definitely associated in 1915 and REMEDIAI~ ~I~ASURES, 1916 with excessive mortality from influenza-- an association likewise found in 189o-92 and Turning now to remedial measures, the war 1899-19oo. It is interesting to compare these has inevitably had a crippling effect upon anti- figures with those for the administrative tuberculosis administration. On the other County of Lancashire. The increased mor- hand, the achievements of certain areas have tality from Pulmonary Tuberculosis is shown been str!king. Thus in Lancashire, as in many by the following figures :- other counties, the County scheme has been Deaths from Phthisis developed, and nOW includes comprehensive Pulmonary Tuberculosis. Death:rate. arrangements for the diagnosis and treatment 1913 ...... 1,441 ...... o.82 of all forms of tuberculosis occurring amongst 1914 ...... 1,523 .... ... 0.87 the non-insured as well as the insured to- 1915 ...... 1,614 ... ... o.96 gether with about 520 beds in various institu- 1916 ...... 1,685 ...... 1.o 4 being the highest ~:o,te reeor'.d~d since 1899. tions. Special attention is paid to th~ I918. PUBLIC HEALTH. 125 Domiciliary Supervision of patients with a Council, and of these only one had received view to increasing the efficiency of home treatment previous to joining the Army. Thus, treatment as well as minimising the chances of out of a total of 4o3 discharged tuberculous infection, while over IOO beds are reserved for soldiers, 29 or about 7 per cent. had received the nursing and isolation of advanced infectious treatment previous to joining the Army. eases. In addition, the care and after-care Similarly, in the Borough of Wigan~ 36 dis- of patients is entrusted to a number of flourish- charged tuberculous soldiers were dealt with ing voluntary committees acting under the to the end of February, 1918 , and of these guidance of the tuberculosis officers and dis- 3, or 8. 5 per cent., were known to be suffering pensary nurses. The growing appreciation from tuberculosis previous to joining the Army. and co-operation of the medical practitioners is In England the number of insured men dis- illustrated by the fact that there were in charged from the Army and Navy for Tuber- my area 682 referred for diagnosis, etc., culosis up to 3othSeptember, 1917, was 8,42o. during 1917. In view of the likelihood of a Lord Charnwood, in " Recalled to Life/' for continued increase in the mortality from September, I917, states that of every I,OOO Pulmonary Tuberculosis during the next few disabled men (excluding officers) so far dis- years, the extension and development of anti- charged from the Forces during the war, ~24 tv.berculosis schemes is of vital importance. were suffering from diseases of the chest including Tuberculosis, which he estimated THE AR~t¥ AND PULMONARY TUBERCULOSIS. accounts for 6o cases, or 6 per cent., of the In the early - part oI the war a number of total. tuberculous men were accepted for military The treatment of tuberculous soldiers now service, partly on account of their own mis- seems to me to be fairly satisfactory. The statements and partly owing to the existence responsibiIity for their institutional treatment of the disease being overlooked at the medical on discharge now rests upon Insurance Com- examination. The increasing co-operation mittees, which usually extend their arrange- between Military and National Service Medical ments with County and County Borough Boards and the tuberculosis officers should Councils. The granting of a short furlough result ;n few cases being missed in future. previous to entry into civil institutions, the The healthy out-door Conditions under which grant of special allowances to dependants of s, Adiers frequently live are more than counter- men during treatment in institutions, and the balanced by the hardships to which they are knowledge that one-half of the pension may be liable and the periods of stress and strain which withheld if medical treatment is not saris- are inevitable on active service. On the other factorily carried out, have resulted in a smooth- hand, Morichau-Beauehant, of Paris, has pub- ness of working, which was absent at an earlier lished some fairly satisfactory figures with period. Exchequer grants are payable to regard to 3o2 French soldiers with a history of Insurance Committees towards the cost of pre-war tuberculosis of lungs. Of these 39 per institutional treatment. cent. had continuously rendered satisfactory On discharge from institution, ex-soldiers service, 25 per cent. had had to drop once for a receive domiciliary treatment and dispensary time, while the remainder had dropped out two supervision precisely as civilians. or more times. In view of the uncertainty of In addition to the above arrangements, the such cases and the risks to other men in the Ministry of Pensions has instituted at the cost same dug-out, hut or billet, it is safer to reject of Exchequer funds a seheme for the institu- all eases of definite Pulmonary Tuberculosis. tional treatment and isolation of discharged The following figures dealing with discharged tuberculous soldiers, whose restoration to any tuberculous soldiers in the administrative material degree of working capacity is impro- County of Lancashire up to the end of 1917 bane and whose conditions render it desirable are of interest in this connection: 309 men in their own interests that they should be were referred to the Lancashire Insurance inmates of a residential institution. This Committee by the Insurance Commissioners provision only applies to such men as are willing and sent direct from Military hospitals, and of to avail themselves of it, and the same weakness these 28 had received treatment previous to in the scheme is apparent as exists at present joining the Army. In addition, 94 discharged for the civilian population generally. With soldiers received treatment in the ordinary way the gradual increase of accommodation for through the Insurafice Committee or County advanced eases, it should be practicable to i26 PUBLIC HEALTH. AuGusT, obtain generally that element of compulsion It may be mentioned here that there has which already exists under local acts in certain been a marked change in the attitude of towns. medical practitioners to midwives: In former Finally, the war has quickened the interest times many medical men resented, or at any taken in the question of the so-called Farm rate merely tolerated, the presence of a mid- Colonies, which have been worked successfully wife in their locality, but this is now very in isolated instances in Scotland and England.
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