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the time spent in their investigation, because apart from the
fact that those who are found tubercular are generally in the early
stage of the disease, and therefore amenable to treatment, there is a
considerable residue, more particularly among children, who are
debilitated as a result of other causes, and whom it is possible to
refer to appropriate agencies for treatment. This treatment and
the resultant continued supervision probably play a considerable
part in preventing them from subsequently manifesting the
disease clinically in its active forms. Cases which are sent up by
doctors or through other sources, who are living in contact with a
tubercular patient, but who attend by reason of their suffering from
suspicious symptoms, are, by instruction of the Ministry of Health,
classified as new cases, and not as contacts.
The Public Medical Treatment of tuberculous persons is undertaken
either in institutions, at the Dispensary, or, in the case of
insured persons, by their panel practitioners. Cases treated at the
Dispensary are limited to those who are uninsured and are not in a
position to pay a private practitioner.
Institutional treatment is now entirely in the hands of the
L.C.C., the local infirmary having been taken over in April, 1930
by that body. There is somewhat marked differentiation between
the provision made for children and for adults. Cases in children
are rarely pulmonary, the great majority being of the type called
surgical tuberculosis, affecting bones, joints, abdomen, glands, etc.,
and it is always possible to secure their early admission to sanatorium,
and their retention there till they are fit to return to their homes,
which may at times entail a period extending up to several years
continuously. The results, I think, can in the main be classified as
extremely satisfactory.
The residential treatment of adults is on a rather different
footing. The greater number are suffering from pulmonary disease,
which may remain active for several years, and it is not possible to
provide sufficient accommodation to keep them away during the
whole of their illness, even if they were willing to stay. It follows that
a selection has to be made, and persons most likely to make good