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Out of the 12 patients who have completed three months' treatment, 7 are at present in full
work and 1 is able to do it if he could get it.
None of those in full work have changed their occupation.
One death has occurred, that of patient No. 3. In July she went for a long walk of 12 to
14 miles in the county, which fatigued her very much and apparently caused a recrudescence of the
mischief in her lungs. She was treated at the tuberculosis dispensary and recovered fairly well, but
took a sudden attack of heart failure, which resulted in death.
The great difficulty with all the patients is their not being able to get suitable work, and in
many cases work of any kind after they leave the sanatorium. If it were possible to get all the
patients work in the open air, or at least under healthier conditions than they were working under
previously, there is no doubt the results would be very much better. Case No. 11 is a very good
example of this. He is working in a dusty room for 12 hours per day, and during the busy season
at Christmas he frequently worked 17 hours per day. Under such circumstances it is remarkable
that he has been able to maintain his health at all. Could some systematic plan of " after care "be
adopted, whereby suitable employment could be assured, the value of sanatorium treatment would
be more than doubled. At present their situations are often filled up, and the two or three months
immediately following the sanatorium treatment are often spent in semi-starvation looking for
work. This period is undoubtedly a most important one, since in these two or three months special
care and good food are needed to confirm the healing process which was completed, or nearly
completed, by the open-air treatment.
Tuberculosis Dispensary.
I was asked to report on the advisability of starting one in Bermondsey, and the following
came before the Public Health Committee in January, 1911. It was then adjourned till the
following meeting, and on the Committee being informed that the Central Fund were thinking of
starting a voluntary dispensary on the Edinburgh plan, they dropped the matter after a final
adjournment for six months.
In a previous report to the Committee it was pointed out that there are three classes of
consumptive patients—1st, those which are in a very early and curable stage; 2nd, those in which
the symptoms, though marked, are not sufficient to preclude them following their occupations; and
3rd, the advanced cases in which there is no hope of either cure or amelioration. To these a fourth
class might be added, viz., those suffering from tuberculous disease of other parts of the body
besides the lungs, which class contains a large proportion of the child population.
These four classes may therefore all be included under the one term, " Tubercular Diseases.
Up to a recent period efforts have been mainly directed to the first and third classes, on account of
the curability of the former and the infectivity of the latter; but the efforts to deal with the second
and fourth classes, which comprise the bulk of tuberculous subjects, have been unequal and
spasmodic, and an organised attempt has only been made to fill this gap during the last two or
three years by the establishment of tuberculosis dispensaries.
The originator of the tuberculosis dispensary is Dr. R. W. Phillip, who started one in
Edinburgh as far back as 1887, and it is the remarkable success he achieved by it that has induced
sanitary authorities not only in Great Britain but in most other civilised countries to imitate his
method.
The general aims and objects of a tuberculosis dispensary are to provide a place where
treatment and advice in all matters pertaining to tuberculosis can be obtained free of charge by the
poorer inhabitants. It is intended for those who are too poor to pay for medical advice.
Owing to dealing with one disease only, the very highest expert advice is brought to bear on
the subject, and the medical officers in it can act as referees in any case in which their advice is
desired by other practitioners.
It is now recognised that tuberculosis is essentially a home disease, and any treatment which
does not take the dwelling of the tuberculosis subject into its purview is necessarily incomplete. It
is useless treating a consumptive patient if the surroundings in his home are not properly attended
to, and the object of the dispensary is to supply advice to the individual both as to personal hygiene
and the hygiene of the home. The dispensary is also intended to act as a co-ordinating centre
between the municipal authority and the various voluntary agencies which are working for the
stamping out of tuberculosis. One most important part of their duty is, therefore, besides examining
and treating the patients, to divide them into the various classes with a view to deciding what kind
of supervision or treatment is best.
Suitable cases are selected for sanatorium treatment; those not suitable for this purpose, but
still able to follow their employment, are advised as to the best kind of work they should engage in,
and assisted in getting it, as to how to take advantage of fresh air, &c., in the home, and in case
food or money is needed sending them to the proper quarter for it.
Another important duty of the medical officer is in visiting the homes to persuade the
" contacts," i.e., the other members of the family of the phthisical patient, to be examined with a
view to discovering fresh cases in the early stage. The majority of the poor people will not consult
a doctor for occasional coughs and colds, which they look upon as of trilling importance, but which
may really be the beginning of consumption, until it is too late.
As regards class three, steps are taken to get them sent to an infirmary or other suitable
institution, and the fourth class receive advice or recommendation according to the nature of their
case-for instance, tuberculous children of school age may be sent to open-air schools or suitable
hospitals for treatment.
Those found to be suffering from any other disease than tuberculosis are referred to a
hospital or private practitioner, as the case may be, for treatment.
Another very important duty of the tuberculosis dispensary is the following up cases which
have undergone sanatorium treatment and finding them suitable employment.