General measures of hygiene find their most important appli cation in arrangements for the conscientious notification of diagnosed cases, the inspection of "contacts," the medical inspec tion of school children, the provision of "clean milk," the better ment of housing, the adequate disinfection of contaminated articles and places and tactful and efficient "health visiting." Recent Methods of Treatment.—Symptomatic treatment, while often affording relief, cannot cure. Even "specific" treat ment aiming at the production of immunity, while helpful in cer tain patients, has proved disappointing. Tuberculin, in its various forms, is no longer regarded as "a cure in the strict sense of the term" and is not entirely free from risk. The natural power of the human body to amplify its powers of resistance is very great and many cases do well if placed under favourable conditions of life. In this lies the secret of "sanatorium treatment" in which the mode of life of the patient is carefully adjusted to the limits imposed by his disease. Within these limits he can exercise and work with benefit to himself and an increase in the amplitude of his resistance. For the more favourable types of pulmonary cases, sanatorium treatment offers a very definite prospect of restoration to average health and working capacity. Although so much stress is laid on controlled exercise and work, the basis of the treatment is rest. In the case of "surgical tuberculosis," too, where the bones and joints of the body are affected, we find in rest the greatest of all adjuvants to recovery. A study of the results attained at such English centres as the Treloar Hospital for Cripples at Alton, the Shropshire Orthopaedic hospital, the North Wales sanatorium and the Metropolitan Asylums' Board hospital at Carshalton will suffice to prove the curability of sur gical tuberculosis in children by judicious immobilization and rest. Fresh air (see PUBLIC HEALTH), sunlight (see HELIO THERAPY) and also the artificial sunlight produced by arc lamps are being used, more and more, to help on the results of treat ment by surgical rest, and wonderfully favourable results are already claimed for these methods.
In pulmonary tuberculosis, too, the method of "surgical rest" for the affected part is applicable where the disease is confined or almost confined to one lung; and new vistas are being opened up through the use of artificial pneumothorax, apecolysis and thoracoplasty. Nothing is more certain than that the surgical treatment of pulmonary tuberculosis is destined to play an in creasingly beneficent part in the future. But, while all these methods are of proven value in appropriate cases, none of them can be claimed as a cure, and it is to Chemiotherapy that we turn in our hope for the future.
Robert Koch found that salts of certain metals, and especially gold, had a lethal effect on the tubercle bacillus but only in con centrations which were also deleterious to the tissues. Research however, has continued on these lines, and Prof. Mollgaard, of Copenhagen, has succeeded in producing a gold compound, sodium aurothiosulphate or Sanocrysin, which, while still under test, ap pears to have a definitely lethal effect on tubercle bacilli in the human or animal body, in concentrations which are non-toxic for the patient. Here, again, we appear to be upon the threshold
of a great advance in the treatment of tuberculosis. The method, however, is not without danger. (See THERAPEUTICS.) Tuberculosis Schemes.—Up to the end of 1910, the work of fighting tuberculosis in Great Britain was left, for the most part, to the initiative of the more progressive local authorities, supple mented by private enterprise and the work of voluntary organiza tions. Much knowledge was accumulated through the work of the Royal Commissions of 1890 and 1901 and through the ac tivities of the Local Government Board, but there was no co ordinated national effort to deal with the disease.
In Nov. 1911, it was made incumbent on every medical prac titioner attending on or called to visit any person suffering from pulmonary tuberculosis to notify the case immediately to the medical officer of health concerned. These regulations, the out growth of orders by the Local Government Board of Dec. 1908, were made applicable to all forms of tuberculosis in Dec. 1912.
In 1911, too, the National Insurance Act made provision for sanatorium benefit for insured persons, the Local Government Board being empowered to authorize county councils to provide, maintain and manage institutions for the treatment of tubercu losis. Under the Finance Act, 1911, and the Insurance Act, a sum of /1,5oo,000 became available for provision of or grants in aid toward sanatoria and other tuberculosis institutions while the Government undertook to pay 5o% of the annual cost of the anti-tuberculosis work carried out by local authorities. The Public Health (Tuberculosis) Act of 1921 placed a statutory obligation on each county and county borough council to make arrangements for the treatment of all persons suffering from tuberculosis, whether insured or not.
Finally, in 1911, a departmental committee, presided over by Major (now Lord) Astor, was appointed to report on the gen eral policy in regard to tuberculosis in its preventive, curative and other aspects. The tuberculosis schemes now operative everywhere throughout England, Scotland and Wales are based, chiefly, on the report of the Departmental Committee.
The units in a complete scheme are as follows: I. The Tuberculosis Dispensary or Institute.—The functions of this unit are to be "a receiving and clearing-house and a centre for diagnosis, consultation and observation, where persons can avail themselves of the services of specially qualified medical men." On the dispensary or institute is based, too, the work of the tuberculosis nurses and visitors "who advise and instruct patients in a hygienic mode of life" and help the tuberculosis officer to keep in touch with the homes of tuberculous cases.
2. Residential Institutions.—These consist of sanatoria for the more favourable cases and hospitals for those patients unable, at the moment, to benefit by sanatorium treatment. The schemes include arrangements for home nursing, dental treatment, pro vision of extra nourishment, training in new occupations and "after-care." For a full account of this subject a pamphlet on "Anti-Tubercu losis Measures in England," by Dr. F. J. H. Coutts, C.B., senior medical officer, Ministry of Health, may be consulted.