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of a properly instructed Health Visitor, and is not suitable work for a male sanitary inspector.
Where possible, all rooms should be sprayed weekly (as at present done), sputum-pots provided,
and a precautionary leaflet distributed.
This health visiting may be very advantageously done, as sketched above, but the Council
have powers to extend this work and do a certain amount of treatment. This extension could
take the form of the tuberculosis dispensary. A dispensary was first started in Edinburgh over 25
years ago by Dr. Phillips, and has been extensively copied all over the world. One of the latest
municipalities to take it up is that of the Borough of Paddington; here a house was taken and
fitted up as a dispensary by voluntary subscriptions, and in it patients who are suffering from,
or suspected to be suffering from, phthisis are systematically examined, advised, given medicine,
weighed, &c. The staff consists of a doctor, nurse, Health Visitor and porter. Cases are visited
at their own homes where necessary by the doctor, followed up by the Health Visitor. The
dispensary is under a committee, who work in conjunction with the Borough Council and the
various philanthropic agencies in the Borough. The cost is about £700 per annum.
This work could also very suitably be undertaken by the Borough Council, but it would
require additional staff and accommodation.
(b) Special.
There are certain special measures which are recommended in the Memorandum of the
Medical Officer of the Local Government Board, copies of which have been supplied to the Committee,
and I shall consider them in connection with the three classes of patients mentioned
previously.
Classes I. & II.—Now of these Class I. is the most suitable for the out-door sanatorium
treatment, and this the Borough Council are entitled to expend money on by virtue of the Public
Health (Tuberculosis) Regulations of 1908. These give power under Section 75 of the Public
Health (London) Act, 1891, to provide hospital accommodation for certain infectious diseases.
Endeavour has been made in London during the past eight years to get some central body, such as
the Metropolitan Asylums Board, to take the matter up and provide sanatoria for cases of comsumption,
but nothing whatever has been done towards this; and while public bodies are arguing who is
to take the matter up, I think it is the best that the Borough Council follow the example of
Woolwich and contract for the use of beds in one of the private sanatoria.
The above Borough contracts for seven beds at a cost of 28s. per bed when they are occupied
and 20s. when unoccupied, but the charge is now raised to 30s. The institution is the Peppard
Sanatorium, and the results so far have been very satisfactory. In 1908 38 patients were admitted
and 38 discharged. Of the discharged 14 stayed one month, 8 two months, 6 three months, 5 four
months, 3 five months, and 1 six months. None died in the sanatorium, and all but 3 returned
home improved in general health and showing increase of weight.
There are generally more applicants than can be admitted, but the cases have to be carefully
sorted out before sending, since many are too advanced to receive any benefit. When patients come
out of the sanatorium they should be systematically visited and helped, where necessary, to get
occupations which will be suitable for their condition, otherwise much of the benefit of their stay
there is thrown away.
Another measure which could with great advantage be adopted for this class as well as a
portion of the second class is the provision of wooden shelters, where they would have an opportunity
of carrying on the open-air treatment in their own homes.
The Paddington Dispensary have four such shelters in use, which cost £4 10s each. They
consist of movable wooden sheds, closed in on three sides and completely open on the remaining side.
They are large enough to contain a single bed, and the patients soon get used to sleeping out in the
open air. I visited two which are in use in Paddington, and both the patients, who belonged to the
working class and had been sleeping out for a year in these shelters, which were placed in their backyards,
expressed themselves as highly satisfied with the result, and feeling much the better for it.
The provision of such shelters, however, is closely bound up with the question of health
visiting, which must be systematically done, to see that proper use is being made of them.
Another measure which would apply to these classes as well as the more advanced cases is the
provision of separate beds and bedroom accommodation for those cases in which the homes are overcrowded
and in which the patients are obliged to sleep in a room with other members of their family.
This is extremely common in Bermondsey and could be remedied to some extent by the letting out
on loan of single beds, so that the patients would not be so likely to infect their relatives. In a
certain number of cases also an extra room could be hired in the house, so as to give the patient In
opportunity of sleeping alone. The disease, as is well known, is specially liable to spread from
husband to wife, and the same remark applies to children which sleep in the room with phthisical
parents.
Class III.—As regards precautionary measures which are to be taken for advanced and
incurable cases, we are greatly handicapped. The proper method undoubtedly is for them to be
segregated in suitable homes or hospitals, and the provision of these should form part of a general
scheme by some central body. In the meantime, however, the only available institution we have is
the poor law infirmary, and there is, as previously mentioned, a great aversion to this. I think it
is a great pity that the Bermondsey Guardians, when altering the infirmary recently, did not bring
the building a little more in line with the requirements of the modern treatment of consumption,
as suggested by me, so as to induce consumptives, especially advanced cases, to enter and remain there.
In view of the above considerations, I beg to put my recommendations in definite form as
follows. lam not mentioning the question of the tuberculosis dispensary, since while I think such
an institution very desirable, I prefer to leave it for a future occasion.
(a) That cases of phthisis remaining at home should he visited as hitherto by the
Medical Officer of Health, these visits to be followed up by systematic periodical visits
of the Health Visitor.