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have been established a decline has occurred in the death-rate from
tuberculosis not less than in those where they have been in force.
If such an institution be associated with a band of voluntary
helpers who realise that there is a more important side to the
question than the bacteriological, much good must result, for its
benefit will be proportionate to its dealing with the circumstances
and surroundings of patients apart from their ailment. Such
helpers will find out suitable employment both for those who have
been discharged from sanatoria and also for those who for some
reason or other are not considered fit for a residence at such an
institution. They will also, so far as they can, see that those who
are left at home, while the breadwinner is undergoing treatment, get
their proper needs, and alleviate the anxiety which must be a constant
menace to the man or woman who realises his or her duty
to those who are deprived of their main support.
The prevention of consumption will, I am convinced, lie in
general improvement of the housing and feeding conditions of the
population, rather than to the destruction of the germ of a disease, to
the infection of which we are all more or less exposed. Compared
with past years, I notice in other reports an increasing amount of
attention being devoted to this aspect of the struggle against tuberculosis,
and it will be a matter of no surprise if eventually it comes
to be recognised as the only factor that counts.
A dispensary has been established in Camberwell for some
time under the auspices of Cambridge House, who wrote offering
their services to form part of the scheme in this .Borough. The
letter was referred to me for report, of which the following is a
copy:—
Gentlemen,—The point that the Public Health Committee have to consider is
how far such an institution as a tuberculosis dispensary should be affiliated to the
Public Health Department. To bring it under the sole control of the Council would
be to probably lose us many voluntary workers who would render valuable service in
the way of material help, of searching out cases where this help was necessary, and
who would set themselves to try and obtain suitable occupations for those sufferers to
whom a change in this respect is necessary for a cure. It would also probably
diminish the substantial interest that many would like to take who could not
actively participate in its working.
On the other hand, measures for the prevention of tuberculosis are just as much
under this authortity as are the cases of diphtheria, &c., and any delegation of the
duties should only be done, if indeed they are done at all, after anxious consideration.
It seems, therefore, necessary that the Council should recognise that if such
a dispensary were established the Council must be in some way directly interested
in its management. Whether this should be done by appointment of members,
or, on the other hand, of officers of the Council, is a point which needs careful
consideration by the Committee. Personally, I think both should be represented.
For instance; questions will arise as to the locality of the dispensary, how far the
sanitary inspectors are to be charged with the supervision of the patients, &c., and
it is necessary that these points should be carried out in a manner agreeable to the
supporters of the dispensary, and in accord with the responsibilities of the Council.
The advantages that the dispensary would provide, apart from the treatment of
cases unable to afford to pay a medical man, would be that of a nurse, who would be
of great assistance in visiting and tending patients; tuberculin treatment could be
given where desirable, ami that, further, the early cases, which are the most hopeful
from the point of view of cure, would be detected in the examination that would be
made at the patient's home.