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48
provided were made attractive. Small local homes would probably be
the form of institution to be preferred by the patient and his friends
who could visit without the need of taking a long journey for the
purpose. Similar provision is also required for the chronic type of
patient, who, although too ill to work, is yet able to keep about. To
patients of this type (a grandparent or other elderly relative) the
infection of a young family is not infrequently to be traced.
In addition to the treatment provided through public authorities, a
considerable number of patients were treated in the voluntary hospitals,
the majority being cases presenting acute manifestations of the disease
or cases requiring operative treatment; but the need for treatment of
this kind would not appear to be altogether supplied, as 13 cases were
noted of patients who could not suitably be nursed at home, and
apparently had failed to gain admission into hospitals, five being subsequently
removed to the infirmary and three dying at home.
In seven instances among insured cases the patient was recommended
by his medical attendant to apply for sanatorium treatment, and
was refused as " doubtful." The view taken by the Insurance Committee
would appear to be that, although clinical symptoms are present, the
patient is not entitled to be sent to a sanatorium unless or until the
tubercle bacillus is discovered in the sputum, by which time the disease
may have passed from that early stage when treatment is most successful.
In one case of two or three years standing the Insurance Committee
refused institutional treatment on what appeared to be good grounds;
the patient was, however, eventually sent away by the City Council for
a month's training, but although the medical officer of the sanatorium
reported that a great improvement had occurred, and that a six months
stay would probably result in arresting the disease, the Insurance
Committee refused to reconsider their decision and give the patient the
opportunity.
Two only of the 22 insured persons suffering from forms of tuberculosis
other than phthisis received institutional treatment through the
Insurance Committee.
The after-care of patients who are discharged from institutions is
undertaken by the tuberculosis Visitors, assisted by the Health Society,
and forms one of the most important parts of their work. They are at
once visited, and are advised and encouraged to continue the treatment
and habits in which they were instructed in the sanatorium. Sometimes
young patients are assisted to change their trade from an indoor to an
outdoor occupation. But, in the case of older patients, the view is
generally taken that the uncertainty of employment and the fall in
wages, which are inevitable in starting again, more than counterbalance
the evils of the indoor trade to which they already belong.