View report page

114
nature study, practically all their time is spent in the open-air.
It is difficult to demonstrate any immediate and tangible evidence
of benefit, such as marked increase in weight or improvement in
the physical signs of disease, but there is little doubt that these
journeys have a beneficial influence on the general health of the
children.
While there is little difficulty in arranging convalescence or a
short holiday for children, either through the London County
Council or one of the charitable organisations, it is rarely possible
to do this for the adult, whatever his trouble. A patient with
debility or symptoms slightly suggestive of tuberculosis, or the
quiescent case of tuberculosis, is not suitable for sanatorium,
but on the other hand a short holiday may be necessary to build
him up for the winter. If he cannot afford to pay for one himself,
he has to do without and run the risk of a further breakdown in
health.
Concerning the question of holidays generally, I would like to
add a word of warning on the dangers of sunbathing. Indiscriminate
sunbathing may be harmful even to a healthy person,
but to the tuberculous it is a positive danger. In spite of repeated
warnings on our part that patients suffering from pulmonary
tuberculosis should never sunbathe, we find it difficult to control
this craze. Only too frequently do we see a young adult, recently
returned from a holiday at the seaside, proudly displaying his
tan or his blisters, as the case may be, with signs of active tuberculosis,
due to the lighting up of an old latent focus, or still more
frequently with marked extension of the disease. Sunbathing
may be beneficial in certain cases of surgical tuberculosis, but
even then should only be carried out under strict medical supervision.
We are indebted to the School Medical Service for their cooperation
in carrying out the scheme for the supervision of
contacts. To prevent over-crowding of the Tuberculosis Dispensaries,
all healthy contacts, and those who, after a period
of observation at the Dispensary, show no evidence of tuberculosis,
are referred to the School Medical Service. A report on
each child is sent to the School Medical Officer, who keeps the
case under special observation, arranging for periodic
examinations and the keeping of accurate records of weight,
etc. Should the School Medical Officer later suspect tuberculosis
in any of these children, they are referred back to the Dispensary
for further investigation.
I continue to act as Tuberculosis Consultant to the Bethnal
Green Hospital. I reported last year that in view of the increase
of work I contemplated visiting the Hospital weekly, instead of
fortnightly as hitherto. This arrangement, which is now being
carried out, I find much more satisfactory. The routine round