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181
In all 139 recommendations for grants and three dentures
were forwarded to the Public Health Committee.
We received during the year from the Tuberculosis Officer
a report with reference to a particularly difficult type of patient
for whom there is no suitable provision made. These belong to
the class who have a positive sputum and who are not in hospital.
They live at home and remain a grave source of infection to
others. The London County Council provide treatment for
patients in their several institutions, and at times send cases to
such colonies as Papworth and Preston Hall. Patients are also
admitted to general hospitals for isolation. Many, however, who
do not require active treatment, and therefore are not suitable
for retention in an ordinary sanatorium or hospital, are sufficiently
fit to do some work, or at least to be about and occupy themselves
with odd jobs. They are consequently unwilling to enter or remain
for long in a general hospital where activities are necessarily very
limited. These institutions appear to be quite unsuited to this
class of patient, and it is not reasonable to expect some cases to
remain in them. On the other hand, the industrial capacity is
often very small, and it does not appear to be an economical
proposition to send these patients to an established colony. We
have become well acquainted with this type of case, and we readily
endorse the opinion of the Tuberculosis Officer as to the urgent
need in the London area for institutions to maintain chronic cases
where there appears to be little prospect of permanent cure, and
where working ability is greatly lowered. In such a place these
patients could be maintained for prolonged periods and made
reasonably content by not enforcing a strict discipline, and by the
provision of suitable light occupations and amusements. Medical
supervision, of course, would be given, but cases requiring active
medical treatment would be transferred elsewhere when indication
for this arose. Many patients would, of course, refuse admission
to this type of hostel, especially those at present at work, but it is
believed that others would enter, and some would be persuaded
from time to time to enter, especially when they are unsuitable
for sanatorium treatment, as an alternative to transfer to a general
hospital. Further, suitable cases who now would be unwilling
to enter the proposed type of institution, might well have been