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103
A small girl, not obviously tubercular, has been under the care of
the Dispensary for the past 18 months. For a year her weight was
stationary, 3 stone. 7 months ago she was sent away by the Invalid
Children's Aid Association, and her weight on return was 4 stone 4 lbs.
—a gain of approximately 40 per cent. in seven months.
I do think the importance of commencing early in life and increasing
the resistance of the infected child cannot be over estimated, so that
later, the infection conquered, will be a blessing rather than a curse,
for recent statistics go to prove the point that tuberculosis is in a line
with most other diseases as regards immunity, and that infection, if
controlled, does produce a relative immunity.
The figures of contacts under observation for more than the allowed
period of two months is somewhat high. This is accountable for by the
fact that it is my practice to keep under observation contacts who are
in close association with a tuberculous case for as long as they are in
association with such case.
Statistics given by the Medical Officer of Health of cases during
the past five years go to show that Sanatorium treatment is, in most
cases, of little value for the cure of the disease in the poorer classes.
The time allowed is too short, and one notes a steady decline directly
the patient returns to town. There is, without doubt, a valuable
educational result, but this could be obtained by a comparatively short
residence.
A multiplication of country colonies for training and carrying on
trades, on a subsidized basis, would be a step in the right direction.
Local homes for diagnostic observation and for advanced cases, run
on the sympathetic and kindly lines of St. Columba's Hospital, Hampstead,
would be a blessing both to patients and doctors.
As we have to confess our incapability of coping with the disease
when once acquired, at all events, amongst the workers, it would seem
that one should concentrate rather on prophylactic points:—
1. Extending the treatment and after-care for the rare early case.
2. Improving the housing conditions.
3. Segregating the advanced case by homes as suggested above.
4. An endeavour to segregate infecting cases.