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17
and treatment of tuberculosis remains the responsibility of the
major Hospital Authorities, but the After Care, both Nursing and
Rehabilitation has remained in the hands of the local Health
Authority (L.C.C,). No really serious arguments have ever been
put forward for this arrangement and many of us feel that the
reasons were other than scientific or clinical, since as far as
the patients are concerned no competent authority has yet ruled
where the clinical division between treatment and After Care is
likely to be found on examination.
The long wait for Sanatorium admission:
One of the greatest, if not the greatest, problem facing
the Regional Hospital Boards on July 5th, was the extensive
waiting lists of patients awaiting institutional treatment of
one kind or another, inherited from the old hospital authority.
This problem has not lessened and in fact in some areas it has
become worse, and everywhere remains as a running sore in the
efficiency of the New Service. The lack of beds has been
instrumental in changing the policy of Chest Clinics in regard
to new patients. It is fair to say that in most instances
only those cases who are young and in when the prognosis is
likely to be very good ever find their way on to the waiting
list for Sanatoria, so that in fact the official waiting list
bears little or no relationship to the present day local needs
for Sanatorium admission.
In this Clinic only about one third of the new cases, or
old ones requiring re-admission, have been submitted to the
Regional Board for this purpose. The other luckless patients
have been treated as well as was possible in overcrowded and
unsuitable rooms surrounded by their overworked relatives and
susceptible off-spring. Such a situation creates a vicious
circle, in that it will tend to increase the incidence of new
cases in a few years time, and thereby aggravate the existing
burden on our available hospital beds for many years to come,
unless we can hope for a financial outlay on hospital rebuilding
far in excess of anything yet proposed, together with
greatly improved rates of pay and conditions of service for
those who work in the difficult surroundings of Sanatoria.
Home Conditions:
It would be invidious to show up the difficulties we
experience with shortage of Sanatorium beds without at the
same time spotlighting the equally dangerous situation created
by the shortage of houses. Here we are dealing with the
fundamental problem of prevention as far as pulmonary tuberculosis
is concerned. In 1939 D'Arcy Hart and Payling Wright in their
excellent survey of "Pulmonary Tuberculosis and Social Conditions
in England and Wales" showed clearly and conclusively the direct
correlation between bad over-crowded housing conditions and the
incidence rates of pulmonary tuberculosis. In this Borough of
approximate population 130,000 there are nearly 5,000 on the
waiting list for rehousing, including 68 tuberculous families
awaiting priority for rehousing. This priority is only granted
when patients with positive sputa are forced to live and often
sleep in the same room where there are children.
As stated we are only able to arrange hospital or
Sanatorium treatment for early treatable cases. For these more
fortunate patients awaiting a future bed in four to eight months
time, together with the less fortunate with no hope of a bed.
there is the overcrowded flat, in which the whole family, mother,
father and babies live their lives in one or two rooms. Where
the patient happens to be the wife, it is occasionally possible
to provide a Home Help, although the number of women who are
willing to volunteer to look after this type of case, is
understandably small. The number of those available would