Incidentally I consider that some such modified and simplified training in actual nursing would form an adequate background for the special training required to obtain a competent school nurse, tuberculosis nurse, or public health nurse (health visitor); and that under present conditions a three years’ training as a nurse is not the best foundation on which to build the special training required for these public health nurses.
Tuberculosis
7. A serious penalty of war conditions has been the increase of tuberculosis. It is not surprising that the crowding in barracks, the overwork and overstrain, the dirtier habits, and risks from expectoration in massed communities, should have increased tuberculosis among soldiers; both by activating latent tuberculosis and by introducing new infection. Nor is it surprising that under analogous conditions tuberculosis has increased among women, especially at the ages in which the enormous increase in their industrial employment has taken place.
The national anti-tuberculosis arrangements which were made in connection with the National Insurance Act had scarcely been fully organized when the war began. At an early stage it had become plain that in essentials non-insured must be provided for as well as insured, and Government grants of half the approved expenditure on the treatment of tuberculosis in the general population endorsed this principle. There was no reason, therefore, for the continued separate existence of the “Sanatorium Benefit”; and had it not been for political considerations the treatment of tuberculosis would probably already have been handed over to public health authorities, while leaving intact the general provisions of the National Insurance Act as to monetary payments and benefits. The same transference should apply also to the treatment of any disease undertaken at the public expense. The treatment of disease, especially in its more difficult specialist and institutional branches, should become a matter of communal provision, to which every person would be entitled as he is to the common provision under our system of elementary education, or to the common use of free libraries and of drinking water.
There is needed a widely extended propaganda against tuberculosis. The public as well as the medical profession need to be educated, the latter in the carrying out of complete and prompt notification of cases of the disease, and in the use of all facilities provided for aiding diagnosis; the former in the risks of industrial and other dust infections, of indiscriminate expectoration, of alcoholism, of imperfect nutrition, of bad housing, and so on. We all need to learn the folly of imperfect measures against tuberculosis. Complete success can only be attained if we assume responsibility for the whole course of the life of the consumptive. Not only must educational sanatoria be provided—and, still more important—hospital treatment for all the emergencies of the disease and in advanced disease; but in the quiescent intervals assistance must be forthcoming to cover the margin between a living wage and the earning capacity of the ex-patient, and economic assistance must be provided for protecting the patient, and still more his family, from defective nutrition and from infection. To stop short of this is to be extravagantly parsimonious; to do this is to economize in sickness and to secure increased efficiency in future generations. What better work can be thought of for Red Cross volunteers than in supplementing the work already carried out by anti-tuberculosis organizations and in extending and systematizing these agencies. Is not such peace work equal in importance with the war work which Red Cross workers have already accomplished?
Venereal Diseases
8. Venus and Mars are always closely associated, and it is a lamentable fact that one heritage of the war will be a great increase of venereal diseases in our midst. In England we had become thoroughly aroused to the magnitude of this evil even in peace time. The report of the Royal Commission on Venereal Diseases and the propaganda since actively carried out, have led to the taking of measures which I can only briefly enumerate. The duty has been imposed on every county and county borough council of providing aids to pathological diagnosis, and of providing clinics for the treatment of these diseases for all comers, irrespective of residential or monetary conditions. These clinics have been generally started throughout the country, and their use has been widely advertised and encouraged by propaganda in the form of lectures and addresses in factories and to various social groups, and by public advertisement. In addition an enactment has been secured absolutely prohibiting the treatment of venereal diseases except by qualified medical practitioners, and prohibiting the advertising or offering for sale of any remedy for venereal diseases. In addition, arsenobenzol preparations are supplied to medical practitioners who have experience in their use for their own patients.
These measures do not cover the entire ground. The enforcement of police regulations against vice, the detention of infectious persons who cannot be trusted to refrain from spreading disease, the raising of the general standard of sexual morality—until public opinion demands that it shall be as high for men as for women—are among the reforms which are called for.
In encouraging social reform in these directions Red Cross workers have a most fruitful field of work, and they can render invaluable assistance in removing a canker which at present eats into the vitals of the community, and is responsible for untold suffering in women and children, for premature old age and paralysis in men, and for a large share of the total inmates of our lunatic asylums.