A study of the relation between the treatment of tubercular patients in general institutions and the reduction in the death-rate from tuberculosis : report / by Arthur Newsholme.

  • Newsholme, Arthur, 1857-1943.
Date:
[1905]
Catalogue details

Licence: In copyright

Credit: A study of the relation between the treatment of tubercular patients in general institutions and the reduction in the death-rate from tuberculosis : report / by Arthur Newsholme. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    27/30 (page 437)
    'i NK\VS1101,MIv — TMHATMHNT OT Ti nKUCn-AU PATIENTS. i.»7 In some inslanccs llie two qnanlilics liavc varied in opposite directions. The opcralion upon tuberculosis of improved sanitation must necessarily be sought in towns, partly because they are the most allecled by the disease, and partly because it is in towns that l>y far the greatest improvement in sanitation has occurred. The ditfe- rences in the relative incidence of tuberculosis on males and females in urban and rural communities show that the improvement in urban sanitation does not explain the reduction in the death-rate from tuberculosis. The insufficiency of such an explanation is the more evident when Ave remember that the improvement in urban condi- tions has been accompanied and probably instigated by an enormous increase of urbanisation, whicti must have tended in itself to produce a rise in the deatti-rate from tuberculosis, so that the effects of improved urban sanitation must have been absorbed largely in neu- tralising this tendency to an increased death-rate from tuberculosis. Isolation in Sanatoria and other special hospitals, proposed origi- nally for therapeutic purposes, has been regarded in recent years as a probable cause of reduction in the prevalence of tuberculosis. This measure has, however, not yet operated on a sufficient scale and for a sufficient time to have had a material influence on any national sta- tistics. In Germany in particular, a large part of the reduction occurred before many popular Sanatoria were opened. Relief given to the tubercular poor has been partly domestic or out-door and partly institutional or in-door. Such relief has in some countries been carried out very extensively for humanitarian and social reasons, without any intention of attempting to control the spread of tuberculosis. The number of instances in which the point can at present be tested is relatively few, but so far as can be ascertained, the death- rate from tuberculosis has declined to the greatest extent in those coun- tries in ivhich the ratio of institutional to domestic relief has been highest. Institutional relief is regarded by the writer as operating by segregating from the community the most potent foci of infection, while domestic relief helps to retain such foci in its midst. A consi- deration of all the facts seems to the Avriter to justify the conclusion that the substitution of institutional for domestic relief of the consump- tive poor has been historically a main factor in the reduction of the death-rate from tuberculosis. The practical inference from these fads is that the institutional segregation of consumptives should be encouraged by making their institutional Irealment as attractive as possible, and that any substi- tution of out-door for in-door relief should be regarded as a reversion to an evil policy of Avhich the tendency musl be lo increase not only p<aupcrism but also luberculosis.