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113 patients died in Camberwell Infirmary. Comfort is
provided in this Institution for dying patients, and as relatives are
allowed to be with them day and night, the fact that the Infirmary
is local and easily accessible is one of first importance. By way of
contrast let us consider Colindale Hospital, Hendon. This Hospital,
opened in 1920 by the Metropolitan Asylums Board, has 300 beds
for advanced pulmonary cases in males. It is well situated, practically
in the country, and is made as attractive and comfortable
as possible. The hospital is in charge of a well-known expert in
tuberculosis. It, however, is not easy of access from Camberwell
in the case of patients who are dying. Relatives have frequently
mentioned this drawback. It is also a consideration in the removal
of patients to the hospital when in an extremely weak state. 18
Camberwell patients died there in 1922. St. George's Home, Chelsea,
with 50 beds for advanced disease in females, is comfortable, but
not as accessible as the local Infirmary, and the same applies to the
Northern Hospital, Winchmore Hill, where 50 beds are set apart
for cases of advanced disease in women.
Looking at the general question of dealing with advanced cases,
small Homes —" Homes for the Dying"—remain in favour with
some. Reasons can be found against their systematic use. Patients
—not rarely—come out of them alive and wonder why they were
put through so severe a spiritual ordeal. Many patients while in
these Homes have a mental struggle to maintain the "spes
phthisica " that adds so much to their comfort and to their chances
of improvement. The most suitable place in which to treat very
advanced cases would appear to be a local' general hospital or
infirmary, in which tuberculosis of all varieties and in all stages is
treated. The popular estimation of treatment of tuberculosis in
such a hospital is affected favourably in that curable cases are
treated as well as incurable ones. This induces patients to enter, and
their friends urge them to enter. Once inside, if the treatment is
punctilious and in the hands of those judged to be experts, patients
feel it is worth their while to remain, even at the expense of separation
from their families, and their relatives urge and support this decision.
There is no essential reason why a hospital should conjure up an
undesirable feeling of Institutionalism. A hospital can be made
as homely as a small Home. A ward may contain 30 beds or may
be so small that it can only hold one bed. By having wards of
different sizes, all cases can be met as far as possible. It is remarkable,
however, how gregarious invalids frequently are. In such a
hospital the comfort of a large number of patients can be arranged
for uniformly, and this is of importance in any scheme. Bright
wards, beds the last word in comfort, food daintily prepared and of
sufficient variety can, and must be, provided. Medical treatment
should be carefully planned so that relief and comfort can be given
by those most qualified to give it. Take a common example,
advanced tuberculous disease of the larynx. Everyone knows the