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48
prevalent is in most cases an insuperable problem. During the war this
difficulty did not arise. Work was plentiful, wages were high, and air
raids made vacancies for those who had to live in central London and
who desired more accommodation. The question, of overcrowding,
especially with reference to tuberculosis, is not an aggravated one in
Westminster. The problem exists, but not in the form or to the extent
prevalent in other metropolitan districts, where vast communities of the
working classes are housed. On consideration of the reports made on the
home conditions of notified cases of tuberculosis, it may be stated that not
more than 20 per cent, dwell in homes which are insanitary in some
degree or which are the subjects of overcrowding in the sense generally
accepted as a basis for legal notice.
Another difficulty which has already been discussed is the lack of
hospital accommodation or isolation for advanced cases in women and
in men who were civilians throughout the war period. The danger of
infection does not arise so much from the actually bed-ridden cases, but
from those who are partly ambulant, e.g., women in an advanced stage of
the disease who go about their household duties, cooking and washing for
their families though hardly fit to walk. Some of those would be willing
to enter a hospital even if only to enjoy a period of rest. This point also
raises another difficulty, which has previously been brought forward—
that of finding a " deputy mother " for the married woman with children,
who requires sanatorium treatment. A few instances have occurred
where women in an early stage of the disease have been unable to accept
sanatorium treatment because there was no one to look after the children.
Similar circumstances occur among men (non-military or naval), where
the wage earner feels that he cannot afford to lose his wages in order to
spend a few months in a sanatorium. He also feels that on his return
his post will no longer be waiting for him in these times of slack trade and
surplus labour. This question is also associated with the great difficulty
in finding employment of a suitable nature for the consumptive after
sanatorium treatment. This has been discussed in connection with
"after care." In conclusion, the substance of this report may be summarised
in a recommendation which is suggested by the experience more
particularly of the last two years. It may not be practicable, but it
points the way to the methods which in the future, may be the most
fruitful in the prevention and cure of tuberculosis. That is the adoption
of a scheme of treatment and after-care for the general population affected
by tuberculosis similar to that now in force for ex-service patients. This
scheme embraces all ameliorative measures, but, of course, is applicable only
to military and naval "attributable " cases. As a postscript, it might be