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No provision has been made in the way of providing some
shelter whereby the last days of a dying consumptive might be
rendered easier to bear, and by such means to aid a poor household
already hampered by the incapacity to Work of one who had been
a material help. It has been suggested that such homes might lose
much of their usefulness through being known as " Homes for the
Dying." This is a matter for individual opinion, but I know of one
such institution which has such a title to which patients feel no
repugnance, and removal to which is often a melancholy satisfaction
to their friends.
Cases in which tuberculous mischief is suspected by the School
Medical Officer continue to be referred to the Dispensary, and the
Care Committee has continued its work during the year.
But it is obvious that the connection between Tuberculosis and
Housing is of the closest, for the main difficulty that has arisen has
been due to the lack of proper accommodation. This may often be
sufficient for ordinary needs, but there is no margin available for
the extra requirements of the tuberculous patient. Many a one
who has derived benefit from the extra care and salubrity of a
sanatorium when he returns to his old unsuitable home loses all
the advantage that he gained while away.
The number of cases attending the Dispensary in 1921 was—
(a) insured, 1,249; (b) uninsured, 2,198; (c) contacts examined, 1,310.
There were 44 deaths reported from phthisis, of whose existence
we only became aware through the Registrar's return of deaths, and
44 from other forms of tuberculous diseases.
To be consistent, there can be no reason for treating a nonnotification
of a case of tuberculosis different to one of scarlet
fever. It is always possible for the notifying practitioner to express
a wish that it should not be visited, and unless serious and grave
reason existed, such a desire would always be respected.
Of late years a tendency has grown up to regard the raising of
the resistance of the individual to infection as more important and
likely to give better results than the attempted destruction of
infective material. On account of the stress laid on the latter
policy I was never able to give whole-hearted support to the
notification of phthisis, which is so bound up with it. One of the
great arguments in general use some ten years ago in support of
notification was summed up in something of these terms. Here is
an infectious disease admitted to be about as fatal as all the
notifiable diseases, and yet it is not included among them.
Notification seemed then to imply an analogy between tubercle and
the ordinarily notifiable diseases, which does not unquestionably
exist, and that similar lines of administrative action should be
followed, thereby relegating to a subordinate position the indirect
methods which are so valuable and which exerted their efforts long
before the famous question of 1898, ascribed to one of very high
position, and which was expressed as "Consumption is a preventable
disease; why is it not prevented ?"