View report page

130
as long as possible. Perhaps more could be done in this direction if
there were fewer restrictions. The hopeless case, tired of being confined
to bed, might, even if he has a slight rise in temperature, be allowed to
sit up for a little if he feels so inclined. Permission to smoke might
be more freely given. Wireless entertainments should be available in all
wards; the dietary also might with advantage be made more attractive.
It may be argued that it is inadvisable to give privileged treatment to
tuberculous patients, but it must be remembered that theirs is unexceptional
case requiring exceptional treatment, and it is to the public
good, apart from any consideration for the patient, that his sojourn in
hospital should be a prolonged one.
The dissemination of infection, however, should not be attributed solely
to the advanced case. The moderately advanced, or even the early case
who goes about his daily work, is a source of danger if he has not been
properly educated in the necessary precautions against the spread of
disease, and his home conditions are generally such as to make this
difficult in practice. Accordingly efforts to prevent the risk of infection
should be conducted along two main lines—the education of the individual
and the improvement of environment. The consumptive patient is given
personal advice by the Tuberculosis Officers and the visiting nurses both
at the Dispensary and in his home. In detailing the precautions necessary
to avoid the spread of infection, special attention is paid to the disposal
of the sputum, and the danger of indiscriminate spitting explained. A
short stay at a sanatorium, however, is of more value in the education of
the patient than personal talks at the Dispensary. One rarely finds an
ex-patient of one of these institutions, whatever may be his conduct in
public, who would be guilty of spitting indiscriminately about his home.
Sputum flasks are supplied free of charge by the Borough Authorities, but
patients, for fear of being shunned by their fellows, are shy in their use.
The children of an infectious case may be boarded out in the country,
but the scheme has not been successful, as it is difficult to persuade parents
to surrender them to a home they have never seen and which, naturally,
they are discouraged from visiting.
Hygienic improvements in the condition of the home are attempted, and
the family advised as to the best arrangement of the available sleeping
accommodation. Where necessary, bed and bedding may be provided free
of charge. Unfortunately there remain a certain number of homes so
over-crowded that any re-arrangement is impossible, and advice of little or
no avail. Only the provision of a new home will meet such cases. Where
the financial circumstances of the family permit, removal is advised, and
the London County Council and the Borough Council usually give
preferential consideration to the application of such cases for the houses
and flats at their disposal. The lot of those who cannot afford to move
is in some cases truly tragic. Local authorities have the power to provide
homes for these people, and in some instances have undertaken this
responsibility.
The Sheffield Council have already adopted a scheme for the re-housing
of the families of infectious cases of tuberculosis. The ordinary Council
houses allotted for this purpose are subject to the special supervision of
the Health Committee, and, where necessary, a portion of the rent is
remitted. The expense of the scheme is surprisingly small—less than
£10 per annum on each home, surely a negligible amount for such a
measure of public protection and such an obvious benefit to the family.
The difficulty of obtaining employment for the tuberculous is as acute
as ever. The Care Committee are successful in placing a certain number
of our patients, but their power is limited, and they are handicapped by
lack of funds. The time perhaps is not opportune to embark on any