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present exist, for many are patients who will certainly never recover
and they are almost paupers.
The crowded home is thus the only place available for the very
large majority of the poorer consumptives, who, from the circumstances
of their poverty and surroundings, constitute themselves the
chief centres for the spread of the disease.
At the present time it seems that we are running a little wild
on the subject of sanatoria. We are spending almost everything
on what are essentially curative institutions for less advanced cases,
and neglecting to make provision for isolating dangerous cases, and
thus protect others from a disease which, among the poorer classes, is
not often permanently cured when once contracted. Sanatoria, in
which the cure of the disease is the prime consideration, are
therefore of secondary importance to the community as compared with
homes for the isolation of those who, though a source of great danger
to others, cannot be isolated in their own homes.
To furnish a good prospect of cure, treatment in a sanatorium
must be prolonged, and a very lengthy stay is generally impossible
for the class we are considering, but the hygienic manner of life inculcated
in such institutions during a few months' residence is of value
in those cases where they are able and willing to practise what they have
been taught. But those who are patched up by a temporary residence
of a few months only, generally relapse on resuming their work and
returning to their former surroundings. In few cases the permanent
cure of a poor-class patient is effected, but exact data as to the immediate
and remote results of the sanatorium treatment of the poorer classes
who resume their previous occupations and surroundings would demonstrate
a very restricted usefulness of curative institutions for this class.
An economic error is committed by any community which erects
institutions for the treatment of what are, generally speaking, the less
dangerous cases, with at best a poor prospect of cure, while doing nothing
for the isolation of the more dangerous cases which may be responsible
c