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Some observations on the present position of the tuberculosis problem in Edinburgh and London and the means of dealing with it

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WilliamsonDJ_1909redux.pdf (6.979Mb)
Date
1909
Author
Williamson, D. J.
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Abstract
 
 
The great increase in the study of sociological problems by the upper and middle classes, which has characterised the last decade of the 19th and the dawn of the 20th century, has had the effect of drawing attention to the terrible havoc caused by consumption. Not only is it one of the chief causes of death in the community, but it is found to claim its victims chiefly from those in the wage-earning period of life; and both from this fact, and the fact of its causing a long period of sickness and incapacity for work, before death mercifully arrives on the scene, it is now more fully realised what an important factor this disease is in the social evils that lie at the heart of modern civilisation. Although not strictly a "poor man's disease”, it nevertheless draws the greatest number of its victims from among the ranks of the poor. And this is only what we might expect, for we already know that its development and spread is favoured by mal-nutrition, and the absence of fresh air and sunlight, all of which conditions are associated with poverty and slum-dwellings; whereas its growth is retarded and may even be checked, by abundance of good food, fresh air, and sunlight, the perquisites of the rich. Unfortunately, from the lingering character of the illness and its tendency to incapacitate the bread-winner of the family from work, it often has the effect of dragging that family down into a lower social grade and placing it in a position favourable to its own growth and development. Thus a "vicious circle” is formed, the two forces - poverty and tuberculosis - acting and reacting on each other, the whole forming a picture so full of horror and pity, that it is no wonder the nation is at last awakening to the sense of its duty in stamping out, if possible, this scurge of the human race. That the discovery of the Tubercle Bacillus as the essential cause of the disease, did not lead to the immediate advocacy of preventive measures by those entrusted with the health of the nation, may surprise those who know how successfully other infective diseases have been coped with. The pathology of this disease we know is intricate; likewise the specific treatment of it; so that it is not remarkable that greater advances have not been made along these lines; but it is rather astonishing that preventive measures have not been more generally adopted 27 years after Koch’s discovery. It is not that we have lacked the desire to exterminate the disease, nor that the necessary funds have not been forthcoming, but that our schemes have net been laid on a broad enough basis to grapple with the whole problem in all its social and economic, as well as its medical aspects. The different bearings of the problem have "been severally emphasised, and separate schemes have been devised to deal with each of these , but the various schemes have usually lacked cohesion among themselves, thus causing a weakening of the anti-tuberculosis forces as a whole through want of co-ordination and organisation. Two schemes have however been evolved, quite separate and distinct in character, modelled on sufficiently broad lines to deal with the social as well as the medical aspects of the problem. Both have been in existence long enough for one to judge of their value and utility. They are:- 1. The compulsory Insurance System of Germany. 2. The Dispensary System as started in Edinburgh. I. The Compulsory Insurance System was inaugurated in Germany in 1881 by the Emperor William I. By this system all workmen, in Germany are compelled to insure themselves against illness of all kinds, so that there is nothing to hinder men seeking advice and getting examined at the first signs of illness, as there is in this country. Thus Pulmonary Tuberculosis is often caught in the very early stages and fewer patients come for advice for the first time showing signs of advanced disease. This in itself is a very beneficial thing, but the scheme goes further, for the Insurance Companies, finding it to their interest to cure all such cases on their books as soon as possible, have built large numbers of Sanatori all over the country and as soon as the disease is diagnosed, the patients are sent to Sanatoria till they are cured or the disease is pronounced arrested. In the meantime, while the bread-winner of the family is undergoing treatment, his wife and children are taken care of by the Insurance Company, so that the patient himself is freed of all care and worry on their behalf, and has not the inclination to discharge himself from the Sanatorium and go back to work before he is medically fit to do so. This universal Sanatorium treatment has also a marked educational influence, as has been proved in this Country too. There is no doubt that the German scheme is a very good one, but very peculiar to and characteristic of Germany, and it is doubtful whether it could be transplanted into this country without such alterations in our economic conditions as we are not yet ripe for. 2. The other scheme I have referred to, had its birth-place, like many another advance in Medical knowledge and practice, in Edinburgh, and it is the purpose of this Thesis to consider the way in which this system meets all the requirements of the problem in Edinburgh, and also the possibility of controlling the amount of tuberculosis in other large centres such as London by the extension of the same system to those centres.
 
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http://hdl.handle.net/1842/34456
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