Tuberculosis a hidden enemy in our midst

The prevention and cure of Tuberculosis is the concern of everyone, It seriously hinders the Labour Movement in its many sided fight for progress and a better life for all. It concerns:

The Trade Unionist, in his constant fight for better conditions in the factory and place of work, for better rates of pay and shorter hours with less fatigue;

The Co-operator, Mother and Housewife, with her hopes of a decent home for her family instead of poverty, depression and war;

The Youth, those who are most susceptible, with their strivings for a better future.

The Medical Aspects

What is Tuberculosis?

Tuberculosis is an infectious disease that is spread in the same way as Diphtheria or Influenza. It is caused by germs, or bacteria, known as Tubercle Bacilli, which are passed on, mainly in the phlegm coughed up by the infected person. Tuberculosis is not hereditary; even highly infectious parents do not pass it on to their UNBORN child. Naturally it does run in families, because there is a serious danger of patients infecting their near relatives, living in close contact with them, especially the younger ones.

Infection is also caused by drinking the raw milk of cows suffering from what is known as Bovine Tuberculosis. However, this latter form of tuberculosis is no longer a serious problem in the big towns and cities where all the milk is pasteurised, thus destroying the germ. It is still a serious problem in rural areas where raw milk is drunk, and costs the lives of over 1,000 people in this country every year, mostly children.

The lungs are the organ chiefly affected by Tuberculosis. Following infection, a patch of inflammation starts in one lung and may spread to the other. Very often parts of the lung are destroyed leaving small holes.

How does Tuberculosis actually affect the patient? He may, of course, feel very ill, but usually this is not the case. In most instances there is cough and sputum, sometimes bloodstained. The patient may feel tired and irritable, with shortness of breath-and possibly, night sweats, some loss of weight and pains in the chest. Unfortunately. more often than not, in the early stages there may be no symptoms at all and the sufferer is quite unaware that anything is wrong

Why does Tuberculosis affect some and leave others free?

Doctors now know that most people have been infected by the T.B. germ by the time they reach adult life, since they are likely to come into contact with infectious sufferers in every crowded place-in the factory, office, canteen etc., etc. Mass X-ray surveys show that 3 persons in every 1,000 of the adult population are suffering from this disease and so may infect others without being aware of it. How often do we hear the saying “Oh, it’s only a smoker’s cough”

We also know that the healthy, well-,fed, happy and contented individual who is in a steady job, with good wages without having to do overtime, well and comfortably housed, stands a far better chance of resisting any T.B. infection than his overworked, w6rried or badly fed and badly housed fellow citizen.

So, when the standard of living falls, up goes the number of new sufferers from Tuberculosis.

These statements are amply born out by the official figures which clearly show that the number of deaths and new sufferers in industrial towns such as Birkenhead, Bootle and Birmingham, are nearly twice as high as the number in residential towns like Bournemouth, Cheltenham and Brighton. Again, in the big cities, such as London, the slum areas, Finsbury and the East-End Boroughs, have twice as many deaths, from Tuberculosis as Hampstead and Chelsea.

The extent of the Tuberculosis Problem in Britain Today

There are about 314,000 people suffering from Tuberculosis in the whole country. More than 14,000 die every year-over 270 -each week, most of these in the prime-of life between 15 and 50, and when they are of the greatest social use to the country. Meanwhile, more than 100,000 are off work at any given moment, and 10,000 are waiting for a hospital bed. The number of beds per prospective patient is far lower in this country than is provided in Scandinavia or the U.S.A. We must add to this that some 3,000 to 4,000 beds are lying empty because of insufficient nursing and domestic staff to man them.

Youth and Old Age

This disease strikes particularly fiercely between the years of 15 and 25 in women. In fact about 40 young people between 15 and 24 die of T.B. each week in England and Wales. Even between the ages of 15 and 45 it is still the greatest killing disease of all. The older men between 40 and 60 are also seriously affected and are often the unsuspected source of infection in the family with their so called, “smoker’s cough” which they have tolerated for many years.

Industrial Workers

We have already shown that the children born and growing to manhood in the congested industrial centres or suburbs of our big cities, are about twice as liable to contact Tuberculosis as their more fortunate fellow citizens in the residential suburbs and towns. The disease tends to be more prevalent amongst industrial workers generally and particularly those employed in certain trades such as Mining, Pottery, Grinding, Foundry Industry, Boiler Makers, Dockers and Boot and Shoe Operatives etc.

Since in the majority of cases, the working class are compelled by the circumstances of modern city life to live in the cheaper industrial areas, near to their work, their chances of contracting tuberculosis are greatly increased by the badly overcrowded, damp and insanitary houses, which are common in such areas. Added to this is the necessity for the worker to carry out long hours of heavy labour, in order to earn sufficient money to try and keep pace with the rising cost of living, leading to a state of chronic fatigue; facilities for proper rest and relaxation not being available in the areas where the workers live.

Furthermore, relatively low wages, hence poor and insufficient food, together with the constant anxiety about the security of their job and the roof over their head, the fear of going sick, or of being disabled, and the ever-growing threat of war, which has never yet brought any thing but suffering and death! for the workers, all these things prepare the human soil for the growth and spread of the tuberculosis germ. The reduction and abolition of food subsidies and the subsequent ratioining by the purse instead of according to need is contributing to the lowering of the standard of living of the lower paid sections of the community and may have serious effects on health.

Problems of Diagnosis and Treatment

In most of the towns, and in all the villages, in this country the facilities for identifying this disease (which means the X-ray apparatus, fully equipped and staffed Chest Clinic, and local hospital units for the treatment of tuberculosis) are grossly insufficient. The well-known Medical Journal, The Lancet, in its leading article in July, 1950, stated that even in London itself many of the Clinics were so inadequately staffed and equipped as to be quite incapable of undertaking the modern methods of diagnosis and treatment of tuberculosis. The number of Mass X-ray Units available are pitiably few-to tackle the problem properly there needs to be one permanent unit in each town of 250,000 population.

Getting the necessary staff and equipment to discover the disease is only the first problem that has to be tackled. Now the question arises, what about a hospital bed? There are about 272,000 patients requiring treatment in the country and a large percentage of these will need a bed of some sort in hospital, but there are only about 23,450 beds available in England and Wales, and in Scotland the position is even worse. During the 3-6 months that they have to wait in many areas patients frequently get worse and also infect their family. The official Sanatorium waiting list figures should not, however, be taken at their face value, for, in many cases, the patient gets his treatment entirely at home, with or without a short stay in one of the precious few beds at the disposal of the local Chest Clinic, and his name never appears on the official waiting list.

Although having treatment at home is far better than no treatment at all, and is often very successful and a means of saving life, it does throw an added and very heavy burden on the already overtaxed family. When the patient takes his treatment in hospital or Sanatorium, little or no domestic upheaval results. There is no problem of a separate room for the patient, no necessity to board the children out and separate them from the rest of the family, no need for Home Helps, the daily attendance of the District Nurse, etc., etc. But when the patient stays at home all these have to be arranged and in many cases PAID for.- In hospital everything is free. Thus the Tuberculosis patient treated at home is doubly penalised.

The problem of the shortage of hospital beds is not a simple one to solve. Besides providing the bed it also involves increasing the number of skilled nursing staff and providing suitable conditions to attract sufficient young men and women to stay in this very worthwhile occupation. There is a Similar problem with other hospital staff, especially domestics. In spite of the many reasons given the basic cause is the chronic shortage of money to pay reasonable wages and provide satisfactory conditions of service, for what, after all, is a first priority job.

Why the Recent Fall in the T.B. Death Rate has Taken Place

If we consider the most likely causes we can say at once that the recent fall in the T.B. rate is not due to better living conditions, since during this period the overall housing has not improved, cost of living has risen more than wages, food intake has not increased. It cannot be due to a greater number of hospital beds, since these are now practically the same as pre-war. Most probably, the cause is improved types of medical treatment, such as better surgery and new drugs.

The fact that the number of deaths has fallen serves to emphasise the main point made by the Socialist Medical Association, that Tuberculosis is now treatable; only a nation-wide campaign and combined effort by. all concerned is needed to start the process of wiping out this disease for good.

Can Tuberculosis be Cured?

Yes, for it is no longer the dread disease of former times. This is largely a result of very recent advances in surgery and especially the widespread use of new drugs, such as Streptomycin, P.A.S. and Nicotinic acid hydrazide.

If everyone is to be able to take advantage of these new scientific advances, all the necessary facilities for diagnosis and treatment, mentioned above, must be available in every town and village in the country. For, as we have already said, in the very early stages, often when the symptoms are very slight and have developed so insidiously as to have escaped notice, an X-ray picture will show up the patch of inflammation in the lungs. At this stage, rest in bed and special treatment, if started at once, may be able to deal extremely effectively with the patch of inflammation, so that the patient is able to return to useful work within a few months. Of course, successful treatment and cure are feasible, very often when more damage has been done, but it takes longer. Even when quite extensive damage has been done to the lungs the disease process can be halted, but a special surgical operation may be necessary to wall off the damaged portion, or it may be removed entirely. In such advanced cases a return to 100% efficiency is not always possible.

So, it is easy to see how essential Health Centres are. For it is here that your Panel Doctor, if he had the time and facilities, could give you a thorough examination, including an X-ray. The continued absence of Health Centres prevents the General Practitioner, who should be the key man in the battle, from playing his full part.

The Treatment

The main form of treatment is still strictly controlled rest in bed, although patients are less and less being asked to freeze with cold in bleak, isolated Sanatoria. Medical science has proved that something more than rest, fresh air, and good food are needed for most patients. Treatment by Chemotherapy is often necessary as well. The resting of the whole body itself is often not sufficient and the movements of the infected lung may have to be restricted, or rested completely. This is done by putting a small quantity of air into the chest between the lung and the chest wall and thus reducing the negative pressure that normally holds up the lung. In this way the lung can be given as much rest as is considered necessary. If, however, considerable structural damage has been done to the lungs so that it is obvious it will never function properly again a major operation may be advised to collapse permanently the damaged lung. This is known as Thoracoplasty or the lung may be removed by what is known as a Lobectomy or Pneumonectomy. During the whole of this period, of course, the patient needs care and attention by skilled staff, either in his own home or in hospital.

It was mentioned above that in early cases patients can sometimes return to work within nine months. However, in the more serious cases, where valuable time has been lost before the diagnosis was made, it is often one to two years before this can happen.

How do patients Live during treatment

Tuberculosis, unlike the majority of other illnesses, may take, as we have seen, many months or even years to heal. During this long time all the Clubs have run out; the relatives and friends who rallied round so gallantly in the early days cannot help any more and all the precious money in the Post Office has long since gone. Tuberculosis patients who are breadwinners and have given up Work in order to start treatment, will draw their Sickness Benefit and this is, in many cases, added to by extra money from the National Assistance Board. In the case of a married man with two children this is calculated as follows:

77/- for husband and wife (when one: is the patient) or
89/- if both husband and wife are suffering from T.B.,
plus 22/- for the children under 5 (11/- each), or
plus 26/- for the children from 5-11 (13/6 each) or
plus 32/- for the children from 11-16 (16)- each) or
plus 43/- for the children from 16-18 (21/6) each.

As a rule the rent is paid and any special payments like hire purchase can either be put off or covered by the National Assistance Board. However, the National Assistance Board payments are all subject to a Means Test, and every worker knows what this can mean. In any case, the total amount coming in will still be much less than was the case when the patient was in full work -at the very moment when MORE money not LESS is essential, if the patient is to respond quickly to the treatment. The more the patient and his family are worried about where the money is coming from the longer it will take the patient to settle down under his treatment. This itself will cost the country more in the long run. It is at this time of domestic crisis that more money is urgently needed, not only to build up the patient’s strength but to make sure that the rest of the family, and especially the children and young people, can resist the infection from the patient and remain healthy.

All these facts and figures explain why it is often so difficult to persuade patients to give up work and start treatment; to find ways and means of tiding patients over their period away from work, and finally why so many patients give up treatment and return to work too soon.

These facts also give the reasons why-so many patients, who have done extremely well under treatment, have to return to the very conditions of life which caused the Tuberculosis in the first place, often relapse. Each relapse means more lung out of action; one step nearer the state of being permanently incapacitated. The answer to the question “How do I live whilst undergoing treatment” in present conditions in this country is “You don’t live, you exist.”

What kind of Tuberculosis Service do we need in order to provide all this care and attention?

Firstly, there is the Chest Clinic which should be the pivot of the whole service, whether it be in City, Borough or Village. This Clinic must be planned and coordinated, not only as part of the whole local chest service, but as part of the whole Health Service in the locality.

Secondly, this Clinic, fully equipped and staffed (including modern X-ray plant) should, in most cases, be a part of the Outpatient Department of the local General Hospital. Here there should be more beds available, not only for the treatment of pulmonary tuberculosis, but also some beds should be set aside for special investigation of difficult cases, where the diagnosis is in doubt. The number of such treatment beds, available in any one area should be in the region of 10% of all the general medical beds.

This local service should be linked with an Area Chest Surgical Unit or Hospital (the new name for the old Sanatorium). Closely coordinated with these units there should be a series of Convalescent Homes, Day and Residential Open-Air Schools, Day and Residential Nurseries, Sheltered Workshops and Re-training Centres, Hostels for the Homeless and for those patients who remain infectious. In larger towns Night Sanatoria may have an important place.

Today, because, beds are just not available when the patients need, them, about 80-90% are forced to have the beginning and in many cases, all their treatment, at home. Now there is no disputing that this type of home treatment is an extremely useful part of the patient’s cure, and, in many cases, is a life saver, but the patient should not have to be penalised as shown above and pay for part of his treatment at home, just because the Government is unable, or unwilling, to provide all the beds required.

In order to carry out efficient Home Treatment further services to those mentioned above are required locally. These are:

A well-staffed District Nursing Service
Ambulance and Car Service
Home Library Service
Home Help Service
Home Handicraft Service
Invalid Meals Service

These services should all be free.

In order that Home Treatment shall be satisfactory it is essential that the patient should carry out a routine as near as possible to that given in hospital. This necessitates an adequately staffed Chest Clinic so that the local Chest Physician may be free to pay frequent home visits. The Health Visitors should see the patient at least once a week,, and the almoner, or Welfare Worker should visit, from time to time to ensure that the patient is, free from domestic worry.

The Return to Work

Following the period of rest in bed, a very carefully planned course of increasing activity is started, which should end up with the return of the patient to full work, and social activities. This period of after treatment, or After Care as it is called, needs to be extremely carefully worked out in order to suit the patient’s individual needs and aptitudes. In this, particular notice has to be taken of his or her past work and training, and especially of the extent of the disease. The kind of work most suited to the patient for full-time occupation after recovery is then recommended and sought. Many patients are quite unable to do full-time in their original job when first restarting work. Others, again, will never be able to return to their old work; this usually happens with those working in the Mines, sections of the Foundry Industry, Pottery Trades, etc., etc. Others will never be able to carry out full-time work of any sort again. A few, because they are likely to cough up infectious sputum occasionally should work only with others in a similar condition.

In spite of the Rehabilitation and Resettlement Act of 1944, there are very few facilities (and these are limited in scope and capacity) for providing work for partially disabled people of all kinds, let alone for those with Tuberculosis. To begin with, there is no such thing as “light work” in most industries. This means that either the patient has to wait about at home on National Assistance until he is fit to start full-time, or he starts back on full-time too early, and relapses as a result, or he gets a poorly paid unskilled job, loses his morale and never returns to full activity in his old skilled occupation-often becoming unemployable as a result.

On the question of Re-training, the position, if anything, is worse. There are few Government. Re-training Centres and, as far as the patients are concerned, these are unsatisfactory because,

(1). it is necessary for a patient to be able to work full-time before he is accepted at the Centre-thus denying admission to a large majority.

(2). Many of these Centres accept -trainees from a very large area, requiring very long journeys to work (often over an hour in London) or staying in a hostel which means a further period away from home after the return from Sanatorium, and further expenses which the additional Government Grants do not entirely cover.

(3). Conditions in many of these Centres (which apparently have to show a profit) bear more resemblance to conditions in. some of our high-speed production shops than to those one would expect to find in a Rehabilitation Workshop which should be governed by the theory of gradual return to full activity.

The Public Services and Big Industry should provide facilities for the rehabilitation of tuberculous workers as well as for others. What is needed is:

1. Occupational Centre attached to each Clinic.

2. Sheltered Workshop in every town; some of the larger cities will require more than one for the infectious patients and those who cannot return to full office or industrial life. They would be able to work a reduced number of hours, their pay being made up to the Union rate.

3. Special provision in every factory employing more than 50 workers for part-time work for those able to work 20 or more hours a week, under optimum conditions.

4. A Special Re-training Centre in every Borough so that the minimum amount of travelling is necessary, where the patients can start as soon as they are fit to do 20 hours a week, where they are paid full Union wages and have optimum welfare conditions. The work and the conditions in all these Centres should be closely watched by the local Chest Physicians and Welfare Workers, and the local Trade Union movement.

The Social Aspects

Can Tuberculosis be Prevented?

Yes. Medical Science says emphatically that with the new advances in diagnosis and treatment this is now really possible for the first time. But to be told that it is possible is one thing, to understand how to set about it is quite another matter.

For instance, can this problem be left entirely to the skilled workers, the doctors, nurses and other health workers, as long as the people ensure that they have all the materials and tools they need? The answer to this, in our opinion, is definitely No. If there were fine chromium plated Clinics, fully equipped and staffed in every corner of the country, whilst this would go a long way in dealing with one part of the problem, it would not prevent all the good work done in these fine Clinics and hospitals being, undermined after the patient leaves and returns home to the very conditions of living and working that caused him to fall sick with this disease, in the first place. What a crime and waste of public money every relapse is! In practice, far too many patients relapse and do this too often, and each time more of their lungs is put out of action until finally they become chronic invalids, beyond the help of medical science.

So the problem of prevention can really be divided into a medical part and a social part, each overlapping the other, with the social part dominating the scene throughout. In Fact, Tuberculosis is a Social Disease.

What Must we do to Prevent this Disease

1. The first thing that must be done is to make sure that as many as possible of the infectious persons in the population are discovered in the early stages by means of Mass X-ray examination, and for all these sufferers to be able to receive modern treatment, quickly and efficiently, with the minimum of discomfort, and without any cost to themselves (for this is a community disease and the community should pay). It must be realised that the treatment of the Tuberculosis patient by modern drugs can often render them non-infectious and this is to the benefit of the community as much as to the benefit of the patient. It is therefore in the interest of public health that this treatment should be completely free even when given at home.

Thus each year there would be fewer and fewer infectious persons walking about unaware that they are a source of danger to their own and other people’s health. This is a very important first step.

2. The second thing is to make every effort to prevent people from falling sick with this disease in the first place. So, we shall have to take drastic steps to get rid of the bad, damp, insanitary houses, the low wages, inadequate pay, industrial fatigue, the worry about the future, and especially the fear about slump and war. All these things – these blots on our way of life-must become a thing of the past. If we falter in this task we are helping to perpetuate Tuberculosis-wasting money on treatment as well as wasting lives. For prevention of this disease requires a great increase in the housing programme, full employment and a rising standard of living for all. Money spent in this way is a sound investment from the point of view of Health and the National Budget.

So really everyone of us is vitally concerned as individuals, as well as citizens, in some way or another. In this problem we just cannot afford to leave it to the Doctors, the Officials, or the Government, however wonderful their promises or intentions may be. Both as possible future victims and also as fighters in this great campaign for the final defeat of this, the last great infectious disease of our time, the responsibility is YOURS, and OURS, ALL OF US.

3. What about Mass X-rays

The 35mm. miniature X-ray apparatus is very useful in quickly and cheaply discovering anybody suffering from unsuspected lung disease in a large section of the population. We now know that 3 in every 1,000 are suffering from active tuberculosis. However, if all the patients who continually attend their doctors for “Bronchitis” are sent along to the Mass X-ray it is found that 22 per 1,000 are actually suffering from Tuberculosis. Why is this sort of examination not carried out on a large scale? Because there are far too few of these X-ray sets available, and far too many restrictions on the scope and activities of those that are in action. The same answer is given-No money available for health!

Besides seeing that the ordinary “man in the street” has his regular overhaul, these machines should be a permanent feature of every Borough, checking up on school leavers, all workers in contact with children, such as school staffs, nursery attendants, those who handle food, etc. However, routine examinations of this kind will never be fully accepted by everybody until there is treatment immediately available, a guarantee of security of employment and disability pension for those who are found to be in need of treatment. This is still one kind of Social Security for which we have to fight.

4. What part can the Vaccine-B.C.G. play in preventing Tuberculosis?

In this country B.C.G. would be very useful in protecting children and young people entering industry, as it does delay, if not altogether prevent, the development of tuberculosis. In Scandinavia it has been shown that in association with a rising standard of living this B.C.G. is a useful weapon in defeating Tuberculosis. It does prevent the onset of lung and brain tuberculosis in children and gives protection for a varying length of time, possibly for years. Its use is no excuse for delaying other methods of stamping out the disease, but together with better housing and food it will offer protection through the danger periods and it may prevent the development of Tuberculosis altogether.

Summary of Socialist Medical Association proposals

1 (a) To discover the disease

Mass X-ray facilities available for everybody, with a static Unit for every 250,000 of the population.

(b) To treat the disease

Modern Clinics fully equipped (including X-ray apparatus) and staffed, within easy walking distance of everybody.

An adequate number of beds (approximately 10% of all the medical beds in the local hospital) to be available.

Beds should be available in each locality for the more chronically ill patient.

A Chest surgical hospital or Unit in every town (several in large cities like London).

Full facilities for treatment in the patient’s home to be available including:

(i) District Nurses

(ii) Home Helps

(iii) Day and Residential Nurseries and Schools

(iv) Invalid Meals Service

(v) Libraries and Diversional handicraft Services

ALL THESE SERVICES SHOULD BE COMPLETELY FREE

2. To help the Family Budget

Tuberculosis allowances from the National Assistance Board should be raised to the level of the basic wage until the patient is back in full employment again. Extra allowances to cover special. medical needs and family emergencies.

NO MEANS TEST.

Local Authorities should be encouraged to assist patients financially and otherwise as well as the National Assistance Board.

3 The Return to work

(a) Sheltered workshops. “Remploy”. Near to the patients’ homes, run by Local Authorities and local industry.

(i) For those temporarily unfit to. return to their normal employment.

(ii) For those permanently unfit to return to their own employment and those who are infectious.

Patients should be able to work in these centres anything from 10-40 hours on a five-day week.

Wages to be made up to the Trade Union rates from N.A.B. allowances.

(b) Sheltered re-training centres Near to the patient’s home for those who have no skilled trade and for those who cannot return to their previous trade. Patients should be able to start retraining as soon as fit to carry out a 30-hour five-day week. Wages should be made up as before.

Should be attached to both sheltered workshops and re-training centres and where the homeless and others can be temporarily or permanently looked after.

4. Prevention-. To remove the main causes of this disease.

(a) Build 300,000 houses each year.

(b) Replan our towns and cities

(d) Clean up our factories and, places of work and extend the Factories Act to cover all places of work.

(e) Introduce an Industrial Health Service as part of the N.H.S.

(f) Build Health Centres now.

(g) Extend facilities for B.C.G. vaccination.

(h) Get the Tories out now; and return a strong Labour Government pledged to Peace, Welfare and Socialism.

TUBERCULOSIS CAN BE WIPED OUT IN A GENERATION.

IT IS UP TO EACH ONE OF US TO DO SOMETHING IN THIS CAMPAIGN.

Get your supplies of this pamphlet and other literature from the SMA, 86 Rochester Row, London SW1

Probably 1955

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