[Report 1933] / Medical Officer of Health, Belfast County Borough.

  • Belfast (Northern Ireland). County Borough Council.
Date:
1933
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1933] / Medical Officer of Health, Belfast County Borough. Source: Wellcome Collection.

    177/202 (page 173)
    follow that, if overcrowding leads to tuberculosis, a reduction in the former over a period of years should lead to a reduction in the incidence of the disease in a given area. The figure obtained appears to indicate that this is the case, and that such a third factor as poverty is not necessarily concerned. In the case of Jarrow, it is concluded that the evil of overcrowding is accentuated by the large proportion of tenement dwellings which the town contains. These have few and small rooms, and are in many cases of a very unsatisfactory design. UNDERNOURISHMENT. “ In this connexion the foodstuffs specially studied were meat, butter, fresh milk, and bread. It was demonstrated that there was significantly more undernourishment among tuberculous families, both in Blaydon and in Jarrow. Relatively more bread was consumed, possibly as a means of compensating for a deficiency of the other foodstuffs. Undernutrition was indicated as a definite cause of tuberculosis. It resulted from poverty rather than from a faulty choice of food. Figures showed that tuberculous families con.sumed less meat, butter, and milk per head than the non-tuberculous families. The greatest deficiency was found in the case of milk, where the amount used in tuberculous households was onl}^ 57.3 to 71.7 per cent, of the amount used in non-tuberculous households. Considerations of relative expense and it is deducible therefore, from the fact that this was not the case, that milk is regarded more as a luxury than as a food. The shortage of milk was even more marked in the case of the larger families, containing the greater relative proportion of children, and it is concluded that the data are quite consistent with the assumption that the inadequacy of milk in the diet is a contributory cause of tuberculosis. Another conclusion from the evidence was that shortage of milk had possibly more important aspects than mere undernourishment, and that, perhaps, vitamins, enzymes, or some unknown constituents of fresh milk had a considerable bearing on the body’s defences against tuberculosis. This would support the view of the value of milk as a prophylactic. HOUSING. “ It was shown that insanitary dwellings were more frequently occupied by tuberculous families in both Jarrow and Blaydon, but there was no evidence directly pointing to this being a contributory cause of the disease, although the results were consistent with this hypothesis. The tenement dwellings were demonstrably more insanitary and more overcrowded than separate dwellings. On the data it appeared that tenement dwelhngs, contributed to the prevalence of tuberculosis by reason of the greater overcrowding in them, and not in consequence of lack of sanitation, nor of the greater poverty of their inhabitants. No evidence was obtained of house-to-tenant infection being an occurrence of any importance in the spread of tuberculosis. RACE. “ The study of racial factors was narrowed down to a comparison of Irish and English families, the classification being based on the place of origin of the father of the family. There emerged a relatively high incidence of tuberculosis in the Irish, and possible causes of this are discussed in detail on the basis of the statistical evidence. The evidence indicated that the admittedly inferior environmental conditions of the Irish families would not wholly explain the greater prevalence of tuberculosis among them. Moreover, it appeared that the racial factor which led to the higher incidence was a relative want of immunity to the disease. It is shown that the augmentation of the tuberculosis death rate of Jarrow caused by the presence of a large proportion of Irish in the town is a factor of considerable importance, being estimated at 31 per cent, of the death rate which would prevail in the absence of the Irish. It is considered that this factor is probably more important as a cause of the high incidence of tuberculosis in the area than many of the other factors which have been studied. GENERAL CONCLUSIONS AND RECOMMENDATIONS, “ In addition to the foregoing conclusions the investigation brought to light the important fact that the supervision exercised by maternity and child welfare cilnics was definitely a factor of importance in the suppression of tuberculosis. Confirmation was obtained of the prevaihng local opinion that a peculiarly rapid type of the pulmonary form is commonly met with in the area. Two of the principal factors concerned in this pecuharity are the relatively high proportion of susceptible persons in the population, and the unfavourable housing con- ditions, which prevent the proper care of persons before or after a period of treatment in a sanatorium. Unfavourable environmental conditions in general are considered to be an important cause of the high incidence of pulmonary tuberculosis in children. “ While the report as a whole does not bring to light any predisposing cause of tuberculosis which can be regarded as new or hitherto unknown, it does appear to give the opinions already held concerning the causation of tuberculosis a more scientific value by reason of the experimental and statistical evidence which arises from the investigation. It is urged that