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84
strongly recommend its perusal as a valuable contribution
to our better understanding of the problems
of Tuberculosis. I wish to draw special attention
to Dr. Howell's description of the facilities at the
Dispensary for the efficient diagnosis of Tuberculosis
and the arrangements made there for the comfort and
convenience of patients, also to his remarks about
the problem of the ex-sanatorium patient.
TUBERCULOSIS AND EMPLOYMENT.
There is no doubt that here Dr. Howell touches
upon one of the most vital aspects of Tuberculosis,
the economic and family aspect. Giving a patient
one or more periods of sanatorium treatment is of
little avail if the patient eventually has to return to
an overcrowded tenement in a congested area and to
work under the arduous conditions of modern industry
where speeding up and severe competition for employment
soon drive the weak to the wall, and their families
with them. At present large sums are being expended
on sanatorium treatment, which is as good as wasted
because the work begun is not carried to a satisfactory
conclusion. Large sums are also being spent in
Unemployment Benefit, on Public Assistance and in
charity to support the ex-sanatorium patient and his
family, when he has been compelled to give up the
struggle. This latter expenditure does not figure in
the Tuberculosis Accounts and so we do not realise
it, but it should be remembered if we want to calculate
the actual present cost of this disease. It would
appear to be a truer economy to spend this money on
establishing the patient in conditions where he could
live healthily and earn a living under friendly medical
supervision without overtaxing his impaired strength
or losing heart. The Pap worth and Preston Hall
settlement schemes are the best means so far devised
for securing this. It must be candidly confessed that
well intentioned local schemes for " finding employment
" for the tuberculous are utterly inadequate to