NATURE 



353 



THURSDAY, MAY 19, 1921. 



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The Treatment of 'fuberculosis by Public 

 Authorities. 



THE Tuberculosis Bill introduced by the 

 Ministry of Health having- passed through 

 the House of Commons without material amend- 

 ment, it may be assumed that it will become law. 

 It is an important enactment in its actual pro- 

 visions, and interesting because it constitutes an 

 attempt to retrace the erroneous steps taken when 

 the National Insurance Bill became law in the year 

 1911. 



Under the National Insurance Act the sana- 

 torium benefit was perhaps the most popular pro- 

 vision, with the possible exception of the mater- 

 nity benefit. The sanatorium benefit was boomed 

 in the discussions on the Bill until the idea became 

 fixed in the minds of the general population that a 

 first-class hotel in favoured rural surroundings 

 was to be available for every insured consumptive 

 with a reasonable prospect of the cure of his 

 disease. The limitations and the extent of utility 

 of sanatoria in the treatment of tuberculosis were 

 even then well recognised by physicians ; but the 

 ideas of Insurance Committees were of a different 

 order, and the pressure brought to bear on these 

 committees by insured persons was so great that 

 many thousands of patienis, suitable only for 

 attention in hospitals, were treated in sanatoria, 

 while accommodation for earlier curable cases was 

 deficient in amount. The sanatorium benefit pro- 

 vided also dispensary and domiciliary treatment 

 for insured persons, and in the latter respect en- 

 NO. 2690, VOL. 107] 



croached on the treatment given by the panel 

 •doctors. There was the further difficulty that in 

 counties and county boroughs, the public health 

 committees of which had made provision for the 

 institutional treatment of the entire population, 

 insured persons were in a position hut little better 

 than that of the non-insured, except in respect of 

 treatment at home. 



The fundamental mistakes in the making of 

 these provisions were such as were almost in- 

 evitable when amateur medical and lay opinion 

 took the place of skilled advisers having adminis- 

 trative experience in the treatment and prevention 

 of tuberculosis and in general public health work, 

 of which the prevention of tuberculosis forms an 

 essential part. The best that can be said for 

 the actual provisions of the Insurance Act 

 is that it hurried on the general provision 

 of anti-tuberculosis measures, and that espe- 

 cially the associated large grant for the 

 erection of tuberculosis institutions helped to 

 this end. It is necessary to add that had enact- 

 ments similar to those now embodied in the Tuber- 

 culosis Bill been substituted for the extravagant 

 and inefficiently redundant services provided 

 under the Insurance Act, the efforts of public 

 health authorities would have been much more 

 efficient, the friction of duplicated work would 

 have been avoided, and the present position in 

 regard to the treatment and prevention of tuber- 

 culosis would be much more satisfactory than it 

 is. 



It must not be assumed that the present measure 

 represents all that is necessary for a rapidly suc- 

 cessful, because complete, crusade against tubercu- 

 losis. It removes from the Insurance Committees 

 responsibiUties which they should never have 

 possessed; it agrees to regard as "adequate" 

 those arrangements by the councils of coun- 

 ties and county boroughs for the treatment of tuber- 

 culosis which have already received Governmental 

 approval (many of these arrangements are im- 

 perfect and incomplete); it makes it obligatory 

 on the councils of counties and county boroughs 

 which have not already made "adequate " arrange- 

 ments to do so at once, on pain of action at their 

 expense by the Ministry of Health if they default ; 

 and it gives power for the provision of after- 

 care and for setting up joint committees when 

 necessary. 



All familiar with the actual state of tuber- 

 culosis administration in this country know how 

 partially and imperfectly our present knowledge 

 for the treatment of this disease is being utilised, 



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