phthisis
Tuesday, 7th November 1911 The Scotsman - Tuesday, 7th November 1911, page 10 THE Local Government. Board for- Scotland publish to-day a report by three" of its medical inspectors on " The Administrative Control' of Pulmonary Phthisis in Glasgow." . In an introductory note Dr Leslie Mackenzie, medical member of the Board, thus describes the circumstances under which the report was . Called for: — . Some; years ago the Parish Council, in order to deal adequately with their ¦ sickness, established three largo hospitals—stobhill hospital, the Eastern District hospital , and the Western District hospital. They also extended the Barnhill Poorhouse. But, meanwhile, owing to , the-improved accommodation , the stream of patients demanding treatment has continued to increase , and the pressure on the available hospital and j.obrhouse space has become very great. The pressure on the parochial institutions was not an isolated fact It was the result of the steadily y increasing concentration of the' public" mind on the group of problems due to tuberculosis. Accordingly, instead of dealing simply with a minor matter of administrative arrangement , the Local Government Board for Scotland decided to institute an investigation into the whole facts bearing on the administrative control of pulmonary tuberculosis in Glasgow. These three reports are the result of the investigation. In the' first, Dr Dittmar, medical inspector , summarises and illustrates the . work of the Glasgow Parish Council. In the second. Dr Elizabeth M'Vail , inspector,-describes and illustrates the work done in the section of Glasgow served by Govan Combination Poorhouse, In the third, Dr Dewar, medical inspector deals fully with the administrative measures taken by the local authority for Public health. Dr Dittmar thus describes "the home conditions of some of the cases visited:—In the houses of two apartments it .was the rule to find that the patient (who, in 16 of the 18 families, was the father and bread-winner) slept in a bed in the "room," -while the rest of the family y occupied the kitchen bed. Owing to poverty, in all except two instances, the only fire the people had was in the kitchen. In several instances I found the patient lying on the kitchen bed during the daytime . He was resting, and having no couch or sofa to recline on, he naturally lay down on the kitchen bed. In two instances there was no pretence -whatever of sleeping apart from others. Thus in one case visited, where the father was suffering from phthisis, there were, in the two-apartment house, besides himself, his wife and 7 children from 17 years to 1 year of age. The father had been phthisical for some four years, and had been several times in stobhill hospital during the period. His wife was paralyzed on one side, and had been in this state since the birth of the first child. Of the children , the eldest (a girl, whom I saw) had facial lupus, a skin-disease of tubercular nature; and a second child of five years suffered from hip-joint disease, also of tubercular origin; the other children were said to be healthy. They slept as follows:—In the kitchen bed ^there the father, with phthisis, the half-paralyzed mother, the little girl with tubercular hip-joint disease, and the baby one year old; in the bed in the room slept the others, one of them with facial lupus. METHOD OF DEALING WITH SPUTUM. The method of dealing with the sputum is of importance—indeed of supreme importance^—in phthisis, as it contains the bacilli of the disease. Investigation of how the sputum was actually being dealt with in these 20 cases is, therefore, of interest. With few exceptions, all had been in hospital; some of them for more than on© period of several weeks or even months. All had pocket spit - cups , in the use . of which they had been instructed; and most of them, especially those with little spit, made use- of these spit-cups. But in # cases where the amount of spit was large (and it is very large in some oases of phthisis) the pocket spit-cup was of no use. Thus, in one case, that of a young man far gone in phthisis , there was a domestic washingpail (about half the ordinary size) standing under his bed. This pail, on examination , proved to be more than half full of sputum. It was explained to me that the pail had not been emptied for two days. And here was the poor -wretch in a cheerless room, by no means clean, with no furniture in it but the rickety bed in Which he lay, coughing his very life out into this pail; a pitiful and even disgusting sight. I asked him if he would go to hospital, the parish authorities being -ready to take him there, but he replied, " No, it would break my heart to go to hospital." I was informed that he had never been in hospital, though repeatedly urged to go by the officials of the Dr Dewar's report. In his report on the measures adopted by the local authority, Dr Dewar describes the system of notification, visits by nurses and dispensaries, and pays a high compliment to the staff engaged in carrying on the work. In other parts of his report he proceeds:— Perhaps next in salience to the fact of the association of tubercular disease and destitution is the strange " medley of anomalies which have arisen through the gradual evolution of our law regarding the poor, the ailing, and the infectious sick. When an intemperate workman develops phthisis, his wife and children may be better off than they have ever been before ! When a woman is similarly affected, she, if the wife of an able-bodied man, may get no relief, and have the eighteen months of her declining health embittered, not only by inevitable pain, cough, and feebleness , but by anxiety regarding the condition of her children. If she is a widow, or her children are illegitimate, her condition will be far less deplorable than if she has an able-bodied husband earning an average labourer's wage A like anomaly occurs with regard to thrift. One of the hundred cases above classified was a steady, respectable fellow ^ a good workman, and a good husband and father. He had saved some money. Wtih the supervention of phthisis, his savings gradually vanished. It took years to gather, but only months to scatter them. With dismay he sees them diminish and disannear. There is no one, certainly no official public body, to help. But, so soon as he is actually destitute, his difficulties are at an end! Then, and, not till then, will he find a place in a Poor-law hospital , and his wife and children will receive a. reasonable, if not even a generous, allowance. It is surely to the credit of the authorities, that, they sometimes do better than poorhouses or COMMON LODGING-HOUSES. The proportion of the notified cases associated with common lodging-houses is very large. Dr Chalmers, .writing in 1906, stated that of a series of cases of phthisis coming to the knowledge of the local authority through application for Poor-Law relief, the lodging-houses supplied about one-fourth. Inthese institutions—many of which are admirabl e Of their kind—Do Special precautionary measures arc taken. In these lodging-houses a phthisical person does not always hav? a bed reserved to himself. Upon his removal to hospital or elsewhere efficient disinfection has been the excetpion. Moreover, the men who reside in these houses are usually of careless and dirty habits. When it is added that ventilation is bad in the dormitories at night, and some of the bunks close and of unsuitable shape for free aeration, it would not be surprising if lodging-houses should prove to be frequently responsible for the diffusion of infection and the inoention of the disease. IN-AND-OUT CASES. This phrase is intended to indicate those cases of the indigent class who enter one or other of the Poor-Law hospitals or Barnhill Poorhouse whenever they feel inclined, and leave it so soon as they tire of it. Many repeat this process indefinitely Of one patient i was told that he was " in and out about once a fortnight"- Now, these persons when they are "out" live either in lodging-houses , where there is neither isolation nor preventive precautions , nor {at least in the past) disinfection , or in homes of the poorest, most dirty, most untidy, and, in short, most squalid type. If phthisis be correctly regarded as an infectious disease (no matter how low the degree . of infectivity), is it for the public weal, is it consistent with the public safety, that this strange alternation of institutional with vagrant life should be permitted without any attempt at supervision or restraint ? Nothing is more certain than ' that the public money spent in the isolation and treatment of patients of this class in hospital is absolutel y thrown away so far as any public benefit is concerned aad scarcely less completely wasted if viewed from a philanthropic standpoint Surely the whole system whereby men suffering from an infectious disease go into and out from hospital at their own sweet will, without regard to their own ultimate welfare, the comfort and wellbeing of their family, or the protection of the public, is archaic and indefensible to a degree of RECOMMENDATIONS. Dr Dewar thus recapitulates the measures which are recommended as the outcome of this inquiry. 1.The whole duty and responsibility for the control of pulmonary phthisis should be vested in the local authority (as apart from the relief of dependants rendered destitute by the illness of the wage-earner.) 2. There should be such extension of the accommodation for cases of phthisis as will permit of—( a) a period of educational isolation for all . early or hopeful cases which desire or require it, and (b) isolation of all advanced cases which desire institutional treatment , and are prepared ¦ to accept it for a reasonable minimum period. 3. There should be such modification of the methods of disinfection aa will imply the thorough cleaning of premises by the tenant or owner, the procedure being adapted to suit each case on recommendation made after a visit by an assistant to the ' Medical Officer of Health. . - . 4.Cases which have been notified should be kept under observation so long as they remain a menace to the public health; to secure'this-end,'it should not be impossible to devise machinery based upon the powers conferred by the Public Health Act 5. In the exercise of the- same powers patients who are excreting tubercle bacilli in their sputum, and whose houses or habits make domestic isolation impossible , should be detained in hospital.

Thanks for that Jock. Most interesting.

hope ther's not too many spelling mistakes tc1 !! lol I used(for the first time)the text version of a newspaper cutting

Note that the article deals only with pulmonary tubercolosis, i.e. the attack by this nasty little bacterium on the lungs. This nasty wee bug is properly known as Mycobacterium tuberculosis. Although tuberculosis usually affects the lungs, it can attack almost any organ in the body, - one other common type in Scotland involving bones. In the 1800s, the disease, aka the "White Plague" was responsible for more than 30% of all deaths in Europe, - that's right, - thirty per cent........... And, as many of you have probably read, TB is on the way back, with antibiotic resistant variants. It used to be the case that TB was easily curable with a range of antibiotics, but the problem was that the course of treatment required several months, with many folk stopping the treatment early as they felt better!, thereby only promoting antibiotic resistant variants of the bacterium. A bit like being prescribed a 10 day course of antibiotics for influenza (which won't really help how you feel unless there are secondary infections as influenza is caused by a virus which isn't affected by antibiotics!), and stopping the antiobiotics after just a few days as you feel better, the result being MRSA and similar !! There's been the same outcome with TB, with one particularly virulent form, - I can't for the moment recall the acronym, - resistant to all current antibiotics and with a high fatality rate. In the time that it's taken me to write this post somewhere around 50 people have died of TB, mainly in the Third World - see http://www.gsk.com/infocus/whiteplague.htm btlw

Somebody explained to me recently that antibiotics don't actually kill the bugs, they just put them into a dormant state, and then they are expelled from the body in the usual way; that's why you have to take the whole course of antibiotics, or they will reactivate before they are expelled. Well, I learn something new every day...

With TB on its way it back it puzzles me why the government have stopped vaccinating children against it. I thought my daughter would get it a couple of years ago but now they only vaccinate children who have spent more than 4 weeks in a country where it is considered a risk or those who have parents who were born in one of those countries. Susan

Hi bd, Not sure if you understood what i wrote about the TB vaccinations..I wanted my daughter to have it but she is not allowed it now under new government guidlines..they have withdrawn the vaccination programme for most children. As for the MMR, I am a bit biased against that. My son was a perfectly normal little boy, learning to talk and waving, laughing, very sociable etc...he got his MMR and within a few days was a totally different child and was diagnosed with high functioning autism just before he was 3. I am not saying the MMR caused it, but I am not convinced it didnt have a contributing factor and think parents should be given the option of single vaccines. Anyway, thats me off my soap box now. Susan