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are ex-service men. When the advanced case is recommended to the London
County Council, which is responsible for the institutional treatment of
tuberculosis, the Tuberculosis Officer is usually advised that the Council cannot
accept the case for treatment under its tuberculosis scheme. We can then
only recommend the Infirmary, but this the patient usually refuses until
he is nearly moribund, or compelled by overwhelming economic conditions.
The advanced case thus spends months, or even years at home with his
family, perhaps sharing the same bedroom with several of his children, and
possibly ultimately infecting them. The position would not be so bad if all
these cases bad at some time or other received treatment in an institution at
which they were taught the methods for the prevention of the spread of
infection. I maintain that all cases of tuberculosis, irrespective of the stage
of the disease when it is first diagnosed, or of the possibility of any personal
benefit being derived by the patient, should receive institutional treatment for
a certain period, so that he may be taught the principles of the prevention
(if infection. It may be argued that this can be done at the Dispensary, or
the patient's home, but my personal experience is that this is impossible,
except when the patient is under constant supervision. I have even seen
in a sanatorium, sputum scattered over the path in front of the bedroom
windows. This state of things, I believe, is rare, and, in a properly managed
institution, impossible; but, if such a thing can happen when the patients are
supposed to be under constant observation, it is not difficult to imagine what
may occur in a patient's home. Whatever may be said against sanatorium
treatment, it is rare indeed to find an ex-patient of such an institution, who,
although he may not use a sputum flask when in public, would dream of
expectorating about the floors of his own house.
This fact alone, in my opinion, justifies the expense of a short period (if
residence in an institution, even for advanced cases But I would go further
than this, and state that every advanced case of pulmonary tuberculosis with
tubercle bacilli in the sputum, who is unfit for work, should be kept in an
institution as long as he will remain.
The present practice of sending these cases to institutions far removed
from their homes is not calculated to encourage patients to enter. The patient
who has not long to live wants to be within easy reach of his friends, and
it would appear that a home for each borough, or for two adjacent boroughs,
where the discipline is not so severe as to insist on a hopeless case remaining
in bed for a slight rise of temperature, or to prohibit patients smoking except
in the grounds, etc., is the only solution of the problem.
Facilities for granting pecuniary assistance to patients are limited, but
during 1921 the Ministry of Health sanctioned the expenditure of a sum of
money not exceeding £2 per 1,000 of the population for the provision of extra
nourishment. The Ministry suggested that, owing to the necessarily limited
expenditure to be incurred for this purpose, grants should be restricted to