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44
appliances which have been prescribed for them in hospital. The arrangements
are made through the Almoner's department and the Association
collect the payments or proportion of the cost from the patients by instalments.
Those who are unable to meet the full cost of surgical appliances
are thus assisted by the Association, who contribute the balance from their
funds.
Of the 592 new cases which were dealt with at the dispensary in 1920,
only 31 were found to be suSering from non-pulmonary tuberculosis.
About half of this number had been hospital cases at some previous period
in their history. Only four cases of bone and joint tuberculosis were
entirely fresh cases, i.e., were diagnosed for the first time at the dispensary.
It is therefore apparent that in this City cases of non-pulmonary tuberculosis,
apart from glands, are dealt with at the many hospitals both general
and special, which exist within its boundaries.
(xii) Care and After-Care.—A committee consisting of representatives
of ofiicial, voluntary, and charitable bodies interested in problems of
tuberculosis was formed under the auspices of the London County Council
in 1916. The medical officer of health is its chairman and the tuberculosis
officer attends in the capacity of medical adviser, assisted by the
health visitors, who have intimate knowledge of the social and domestic
conditions of cases. As pointed out in previous reports, the work of this
committee is seriously hampered because there are no funds at its disposal
with which to carry out schemes of assistance for individual cases. The
functions of the committee are defined in its title, Tuberculosis Care
Committee. Those functions include improvement of the home conditions
while patients are away in sanatoria, advice as to change of
employment on their return and assistance in obtaining such employment.
Such bodies as the War Pensions Committee, Charity Organization
Society, &c., &c., report through their representatives on the
committee as to action taken in individual cases and thus co-operation is
stimulated and overlapping avoided. At the present time, however,
the discussions which take place touch only the fringe of the problem of
"after care." It is undoubtedly the most important aspect of antituberculosis
effort and deserves a greater measure of public attention than
has been focussed on it in the past. The tuberculous ex-soldiers are the
only class of cases for whom a serious attempt, at after care has been
instituted. The War Pensions Committee have powers to assist them
with clothing, diet, treatment for dependents, removal to better homes,
and schemes of training for employment. Their treatment allowances are,
or course, the alpha and omega of after-care principles. It has already
been pointed out how moderately-advanced cases among ex-service men