View report page

120
The scheme is working smoothly, and the School Medical Officer and Tuberculosis
Officer arrange consultations when necessary.
The arrangements for institutional treatment have again shown steady
improvement. The period of waiting is less, and no patient has been refused
treatment suitable to his case. The advanced case is no longer the problem
it formerly was, as a large number of beds in the London County Council
general hospitals is now available for this class of patient. There is still
some difficulty in persuading patients to enter these institutions, but it would
appear that the prejudice to these hospitals is becoming less acute. Moreover,
as patients are now frequently offered a choice of hospital, it is often found
that a patient who refuses to enter his local hospital will not hesitate to accept
the offer of a vacancy in a hospital more remote from his home. This increased
tendency on the part of the advanced case to enter hospital should, I feel
certain, have a definite influence in the prevention of the spread of infection.
I still continue to act as Consultant to the Bethnal Green Hospital and
visit the Hospital regularly every fortnight, or more frequently, if required.
The London County Council has recently had under consideration the whole
question of the management of the tuberculosis wards of their general hospitals,
and I am pleased to report that the appointment of tuberculosis officers as
consultants has been confirmed. I think these appointments desirable, as it
enables us to keep in touch with our patients, and the mere fact that we can
assure a patient that we will continue to visit him in the hospital often enables
us to persuade him to enter when otherwise he would not consent. I would
like to take this opportunity of thanking the medical staff of Bethnal Green
Hospital for their unfailing courtesy and willing co-operation.
The results of sanatorium treatment have shown considerable improvement
in recent years. The factors contributing to this improvement are many, but
probably the more important are earlier diagnosis with the aid of X-rays,
the less virulent nature of the disease with an increased individual resistance,
and recent advances in treatment, such as the use of Artificial Pneumothorax
and Sanocrysin, although perhaps it is a little too early to give any decided
opinion on the latter form of treatment.
But the patient on leaving sanatorium has only won half the battle, and
it is to be regretted that a fight so well begun should so frequently end in
disaster. While it is true no panacea has been discovered, it cannot be denied
that medical science has at least done something, only to be thwarted at the
critical moment by economic conditions, as it is only too true that relapses
occur in proportion to the standard of living of the patient's family. What
is the prospect of even the most hopeful case with the disease quiescent on
his discharge from sanatorium ? He has probably lost his job, and the mental
distress occasioned by his hopeless task of finding employment and his inability
to provide for himself and family is only too soon reflected in his general
health. Under such conditions it is not surprising that relapses are frequent.
The majority of ex-sanatorium patients are capable of doing remunerative
work under suitable conditions, but they cannot be expected to compete in
the open market with the able-bodied. The policy of helping a man to
regain his health and working capacity, when the former will probably relapse
and there is no opportunity of taking advantage of the latter, would not appear
to be a very sound one, either from humanitarian reasons or from an economic
aspect. The burden of the tuberculous patient on leaving sanatorium is
usually more than he can bear unaided, and as the trouble at this stage is
mainly economical, none but the State can render efficient treatment, and
the care of the tuberculous, to be efficient, should be continuous and permanent.
I offer no excuse for again urging the necessity for the provision of workshops
subsidised by the State, where patients could work at suitable
occupations under direct medical supervision and obtain a living wage, and
emphasizing the fact that the cost to the State could not possibly be greater
than their continuous maintenance in total unemployment. An extension