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.
