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Part of the debate – in the House of Commons on 13th March 1922.

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Photo of Sir William Cheyne Sir William Cheyne , Combined Scottish Universities

I did not intend to say anything to-night, but the spirit moves me to make a few remarks, especially in regard to the treatment of tuberculosis. First, I must refer to a question put to me by an hon. Member opposite. I did not catch exactly what was said, but as regards the treatment of venereal disease, of which he was speaking, I confess I can see very little difference between the two societies. I cannot understand the antagonism. It is mainly a question of the time of disinfection, a very small question of minor importance. Both societies are doing well and might well be combined. As to tuberculosis, the efforts of the Government are spoken of as a campaign against tuberculosis. I wish to point out where I think the campaign might be strengthened. As far as I can see from the Votes, the campaign consists chiefly in the treatment of tuberculosis, in attempts to eradicate the disease once it has got a firm hold in the frame of the patient. That is quite right, but it would be much better if you could prevent the virus getting into the patient. If you use the word "campaign" and introduce a military metaphor, I should say that what is being done is practically a frontal attack on an enemy which is very strongly entrenched, whereas what the military man docs is to surround his enemy and to cut off his communications. It is not until he has done that that any real progress can be made with the campaign. I think that is the state of things in regard to the campaign against tuberculosis. The results to be secured by devoting the main attention to its treatment are comparatively few. It is very difficult to make progress in that way. The eradication of the disease cannot be secured by such means. The other part of the campaign—the prevention of the disease—is the point, to which I wish to call particular attention. It is rather over 40 years since the virus of tuberculosis was first demonstrated, and during those 40 years there has been an enormous amount of research. I suppose we know more about tuberculosis, the natural history of the virus and the method in which the disease progresses, than we know of any other disease. We have, therefore, fairly definite lines on which to base our attempts at prevention.

Everyone knows that the chief sources of infection are two in number. One is the material coughed up by the patient who has tuberculosis of the lungs. Patients thus suffering are constantly sending into the air particles of moisture containing tubercle bacilli which are a constant danger to those who are living with them. Further than that these particles dry up and are mixed up with the dust, and when attempts are made to dust a room the particles rise up again and are inhaled by people in the room and are thus a further source of danger. These bacilli retain their vitality for a very considerable time, and destruction of them in the sputum is very difficult. If you want to prevent infection segregation of the patient is the really logical method of treatment. Here we can realise the great value of sanatoria. Not only does the sanatorium treatment help to cure the patient—and a considerable number are cured by it if it is only sufficiently prolonged—but it also removes from the home the individual who is capable of infecting the whole family. One knows many cases where members of a whole family with an inherited tendency to tuberculosis have died one after the other, the only one living being the child sent away to school and never coming home. Those who remain at home infect one another and die off. Short of segregation, therefore, I am afraid there is nothing very much that can be done, although steps should be taken to teach the patient how to deal with the sputum, etc. I know it is difficult to get this carried out properly. People suffering from tuberculosis are generally very nice gentle people, and their friends do not like to part with them. But I believe in course of time they themselves, if they realised the facts, would want to go away to a place where they would not infect their relatives. They need not necessarily be cut off from their relatives, but should have opportunities of seeing them. So much for that.

There is another source of infection which requires to be dealt with, and that is tuberculous milk. Tuberculosis is quite common in animals. Many cattle get it, and their milk may become full of tuberculous bacilli, it is drunk by children, and sets up various forms of tuberculous disease, including surgical tuberculosis and tuberculosis of the bones and joints and glands. Something like 30 to 60 per cent, of these diseases in children are due to infection from tuberculous cattle by means of milk, and if we could cut oft the supply of this tuberculous milk it would at once bring about a very large diminution in the incidence of tuberculosis and prevent an enormous amount of injury to children. I have never been able to understand quite why stronger measures are not enforced against this source of infection. I suppose it is a matter of trade, but such considerations ought not to be allowed to prevail. I know that there have been various Bills brought in and a number put on the Statute Book for maintaining the purity of milk, but, so far as I have read those Acts, I do not think that even if they were enforced they would produce the desired result. As a matter of fact, I believe they are in suspense at the present time, and nothing really is being done to prevent this infection. For instance, a friend of mine, a surgeon, was very much interested in trying to ascertain how far children suffering from tuberculosis were infected from cattle or other sources. He had in his wards at one time a number of children who came from the same part of the town in which he was practising. He set to work to try and trace the origin of the disease. He found the children all came from one small area which was supplied with milk from a particular dairy. He examined the milk from that dairy and found it contained tuberculous bacilli. He went further, and succeeded in locating the actual cow which produced the milk. He informed the authorities, and orders were given, not for the cow to be killed and cremated—which would have been the proper course—but for it to be removed from the dairy. The dairyman obeyed the order, and sent the cow into the country. She was sold to a farmer connected with a dairy in another part of the town, and she came back to that other dairy and infected the milk supply there.

The time has come when something should be done definitely to prevent this serious source of infection. The means would be, examination of the milk to ascertain if tubercle bacilli are present in it, and examination of the cattle to see which of them are tuberculous and which of them are yielding tuberculous milk. Of course, it is not every tuberculous cow that yields tuberculous milk, and the injection of tuberculin, and the observation whether fever is produced or not, and the killing of all cattle that react, is not a feasible proposition. Some that react may not be tuberculous, and the great majority will not have tuberculosis of the udder, and therefore will not be particularly dangerous. But wherever an animal is found to be yielding tuberculous milk, that animal ought to be killed and cremated. I received a circular two or three days ago, and it was this circular really that led me to speak. Evidently an agitation is beginning against the Minister of Health, to prevent him from bringing in another Milk Bill. The circular stated that it was understood that the Minister had an agreed Bill. I do not believe he will ever get an agreed Bill that is of any use. I think he will have to bring in a Bill which recommends the proper measures, and to carry it out. The Government, with their very large majority, would have no trouble in passing any Bill that they liked, and I cannot think of any better preparation for a General Election which, I am told, is in the air, than to be able to say that you have passed this Bill with a view to saving the children. It would appeal to the women, who now form practically half the electorate, more than any topic you could take up. In fact, I am not sure that it would not be better if the Minister could arrange to be defeated on the Bill. I know such things have been done, although I do not suppose he would dream of doing it. In that case, however, he could go to the country and say, "I have brought in a Bill which would have saved your children, and those wicked Labour people—or Wee Frees—or Anti-Waste people—have prevented"—