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Tuberculosis and Residence.
451
consumptives in which hygienic and economic have been adjusted to suit the abnormal physical and mental state of its members. The tuberculous subject must work, and the first pracfactors
THE
LANCET.
tical consideration is to make conditions under which he can work to the full extent of his powers. The recent special report on tuberculosis by Dr. JOHN ROBERTSON, medical officer of health for Birmingham, makes it clear that in Birmingham at least it is not the home environment which is chiefly at fault. The mortality-rate in the decade of highest working efficiency (ages 35 to 45) was 4’5 per 1000 for males and only 1’6 per 1000 for females, and yet, as Dr. ROBERTSON points out, women at these ages spend far more time in the dwelling house than do the men. In his address at Cardiff, reported in our present issue, Dr. T. D. LISTER heralds the dawning of the idea that we must try to provide such conditions of life and labour as would render the expensive sanatorium unnecessary. And at the moment the conditions of labour seem most in need of reform, a view that deserves all prominence, for it precludes the relegation of measures for the control of tuberculosis to that day when housing conditions shall be perfect. The intimate association between bad housing and the spread of tuberculosis is too often used as a cover for indefinite delay in preventive
LONDON: SATURDAY, FEBRUARY 21, 1920.
Tuberculosis and Residence.
present-day housewife has been charged with a lack of proficiency in housecraft, when compared with her continental sisters, there is no doubt that in this country as in other countries the family is the economic and economical unit of society. To break up the family, and to shelter one member of it in an institution, apart from dire necessity, is to incur an entirely disproportionate expense for an individual, and this can hardly be justified to tax- or rate-payers in the times immediately ahead of us. There are two essential elements in the economical running of a household. One is the mutual adjustment of tastes, celebrated in a familiar nursery rhyme, so that one member takes what the other leaves; the other is a deeply-rooted instinct to keep down expenses within the limits of the family budget. Both of these safeguards are soon lost in any form measures. On p. 457 of our present issue Dr. F. STANLEY of institutional life, with far-reaching economical In view of these consequences. considerations, TINKER, tuberculosis officer for North-East Surrey, the indefinite extension of sanatorium and training- outlines a scheme for the post-sanatorium employcolony treatment for tuberculosis, however ideally ment of the consumptive ex-soldier which meets desirable, must be regarded as very difficult at the some of the chief difficulties. The scheme includes present time. Fortunately, a larger view of tuber- both training and permanent employment. So long culosis is beginning to prevail, and it is getting to as they are undergoing training the men would be recognised that institutional treatment has its be in receipt of a training allowance from the chief purpose in education, and should be limited Ministry of Pensions, and the financial burden of The to a brief period of tuition in the manner of life the experiment would be thereby relieved. suitable to the tuberculous individual. municipal workshop, which Dr. TINKER suggests, With one proviso. That the individual, having is to serve the requirements of the discharged learned what manner of life he should lead, returns ex-Service men in a population of 75,000, and would to conditions where he can carry it out. Sufficient provide 40 to 50 benches in two workshops, one for food, hygienic environment, and the absence of training and one for permanent employment. economic strain, these are the three essential Assessment of hours of work is to be regulated factors which must be on the side of the individual by a medical officer, .presumably the local tuberwho is putting up a life-long struggle against culosis officer, on a strictly individual basis, the tuberculosis. And the greatest of these is the last. man receiving the trade-union rate of wages for In the modern factory, as Mr. P. C. VARRiER-JONES, each hour of his work, irrespective of the actual WHILE
our
among others, has reminded us, if the pace of operative is slackening, or if he is weak in his attendance, the whole shop is thrown into a state of confusion. The tuberculous worker is either a nuisance to his employer, or risks his health by an attempt to keep up to an impossible standard. But surely it is not beyond the reach of human endeavour to set up special conditions for workers who are incapable of rush against time, and to provide remunerative employment while doing away with the economic strugglethe rock on which so many consumptives are wrecked. Mr. VARRIER-JONES has recently a idealised tuberculosis colony as a community of
an
amount turned out. The manager in control of the business side of the shops would see to the carrying out of the medical officer’s instructions. Dr. TINKER makes large claims for his scheme, the most reasonable of which is that it will not work against any existing proposals, but rather be an adjunct to any of them. The municipal workshop certainly deserves consideration, and especially because it brings the human side of preventive medicine into contact with public affair.s. The problem in respect of the tuberculous subject is seen to be the transformation of a weakly member of the community into one who can shoulder his burdens despite his drawbacks.
consumptives in which hygienic and economic have been adjusted to suit the abnormal physical and mental state of its members. The tuberculous subject must work, and the first pracfactors
THE
LANCET.
tical consideration is to make conditions under which he can work to the full extent of his powers. The recent special report on tuberculosis by Dr. JOHN ROBERTSON, medical officer of health for Birmingham, makes it clear that in Birmingham at least it is not the home environment which is chiefly at fault. The mortality-rate in the decade of highest working efficiency (ages 35 to 45) was 4’5 per 1000 for males and only 1’6 per 1000 for females, and yet, as Dr. ROBERTSON points out, women at these ages spend far more time in the dwelling house than do the men. In his address at Cardiff, reported in our present issue, Dr. T. D. LISTER heralds the dawning of the idea that we must try to provide such conditions of life and labour as would render the expensive sanatorium unnecessary. And at the moment the conditions of labour seem most in need of reform, a view that deserves all prominence, for it precludes the relegation of measures for the control of tuberculosis to that day when housing conditions shall be perfect. The intimate association between bad housing and the spread of tuberculosis is too often used as a cover for indefinite delay in preventive
LONDON: SATURDAY, FEBRUARY 21, 1920.
Tuberculosis and Residence.
present-day housewife has been charged with a lack of proficiency in housecraft, when compared with her continental sisters, there is no doubt that in this country as in other countries the family is the economic and economical unit of society. To break up the family, and to shelter one member of it in an institution, apart from dire necessity, is to incur an entirely disproportionate expense for an individual, and this can hardly be justified to tax- or rate-payers in the times immediately ahead of us. There are two essential elements in the economical running of a household. One is the mutual adjustment of tastes, celebrated in a familiar nursery rhyme, so that one member takes what the other leaves; the other is a deeply-rooted instinct to keep down expenses within the limits of the family budget. Both of these safeguards are soon lost in any form measures. On p. 457 of our present issue Dr. F. STANLEY of institutional life, with far-reaching economical In view of these consequences. considerations, TINKER, tuberculosis officer for North-East Surrey, the indefinite extension of sanatorium and training- outlines a scheme for the post-sanatorium employcolony treatment for tuberculosis, however ideally ment of the consumptive ex-soldier which meets desirable, must be regarded as very difficult at the some of the chief difficulties. The scheme includes present time. Fortunately, a larger view of tuber- both training and permanent employment. So long culosis is beginning to prevail, and it is getting to as they are undergoing training the men would be recognised that institutional treatment has its be in receipt of a training allowance from the chief purpose in education, and should be limited Ministry of Pensions, and the financial burden of The to a brief period of tuition in the manner of life the experiment would be thereby relieved. suitable to the tuberculous individual. municipal workshop, which Dr. TINKER suggests, With one proviso. That the individual, having is to serve the requirements of the discharged learned what manner of life he should lead, returns ex-Service men in a population of 75,000, and would to conditions where he can carry it out. Sufficient provide 40 to 50 benches in two workshops, one for food, hygienic environment, and the absence of training and one for permanent employment. economic strain, these are the three essential Assessment of hours of work is to be regulated factors which must be on the side of the individual by a medical officer, .presumably the local tuberwho is putting up a life-long struggle against culosis officer, on a strictly individual basis, the tuberculosis. And the greatest of these is the last. man receiving the trade-union rate of wages for In the modern factory, as Mr. P. C. VARRiER-JONES, each hour of his work, irrespective of the actual WHILE
our
among others, has reminded us, if the pace of operative is slackening, or if he is weak in his attendance, the whole shop is thrown into a state of confusion. The tuberculous worker is either a nuisance to his employer, or risks his health by an attempt to keep up to an impossible standard. But surely it is not beyond the reach of human endeavour to set up special conditions for workers who are incapable of rush against time, and to provide remunerative employment while doing away with the economic strugglethe rock on which so many consumptives are wrecked. Mr. VARRIER-JONES has recently a idealised tuberculosis colony as a community of
an
amount turned out. The manager in control of the business side of the shops would see to the carrying out of the medical officer’s instructions. Dr. TINKER makes large claims for his scheme, the most reasonable of which is that it will not work against any existing proposals, but rather be an adjunct to any of them. The municipal workshop certainly deserves consideration, and especially because it brings the human side of preventive medicine into contact with public affair.s. The problem in respect of the tuberculous subject is seen to be the transformation of a weakly member of the community into one who can shoulder his burdens despite his drawbacks.