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there is little difficulty in finding more or less suitable employment. The
fact that they have attended an open-air school for tuberculosis children does
not seem to handicap them in this respect, and it apparently leaves no
stigma. Old scholars are not forgotten and left to their own devices.;
the Care Committee still continues to keep a friendly eye on them, while
they are encouraged to attend the Dispensary at regular intervals for the
purpose of supervision.
Institutional treatment has, on the whole, been a little easier to obtain
during the year. Fewer cases have been refused admission, but the
period of waiting is still longer tlian is desirable, and in certain cases may
be detrimental to successful treatment. The period of stay at a Sanatorium
is in most cases much too short for cure of the disease, and this aspect of
the subject, in my opinion, needs urgent consideration.
The problem of the advanced case is not yet solved. There is still
considerable difficulty in persuading the advanced patient to enter the
Council's general hospitals, although this difficulty is perhaps less acute
than when these institutions were under the control of the Guardians,
for patients are more hopeful that they may later be transferred to one of
the Council's sanatoria. In view of the fact that there now appears to be
ample accommodation for this class of case in the general hospital's, it
seems a pity that something cannot be done to induce patients to enter them.
The argument that treatment at these institutions is satisfactory and adequate
is of little avail if patients continue to regard them as General Hospitals,
and feel that no special knowledge or care is available for them. I am
of the opinion that this difficulty could be solved if a few of the Council's
general hospitals were wholly or partly set aside for such cases, and a relatively
greater proportion of the patients of such institutions were later
transferred to sanatoria. These hospitals would acquire the status of
special hospitals, and in consequence would, 1 am convinced, attract a larger
number of patients.
The isolation of the advanced case is of such importance in the prevention
of the spread of tuberculosis that it is worthy of every consideration,
for there is little doubt that the recent remarkable decline in the death rate
from tuberculosis is due in no small measure to segregation. It may be
argued that the complete isolation of the tuberculous would result in loss of
immunity to this disease. The method of obtaining immunity by direct
contact with the advanced infectious case- is, however, not only crude
but dangerous, since neither the dose nor the virulence of the infection can
be regulated so as to guarantee that there will be no damage to health in
the process.
The result of sanatorium treatment, as far as it goes, has on the whole
been satisfactory, but as previously mentioned, in only a few cases has the
stay in an institution been sufficiently prolonged to jensure a cure. A stage
of arrest or quiescence has been attained in quite a number oli cases, but
this carries no guarantee of a permanent cure later.
Frequently the most critical period of a man's treatment is that
immediately following his discharge from sanatorium. The ideal conditions
that prevailed in the institution only tend to exaggerate the jutter inadequacy
of those that await the average patient on iiis discharge. In an overcrowded
home fresh air is almost unobtainable, food often lacking—if not
in quantity then in quality—and proper rest impossible. Moreover the
patient has frequently lost his employment, and fails to find other suitable
work ; hence it is not to be wondered at that relapses are common. In
view of the crowded nature of the homes and the present high level of