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admitted that the immediate results are in the main good, and the
chief criticism is directed towards the fact that they are not always
permanent. For this there are two main reasons: (1)— the
difficulty, which I discussed last year, of securing the early case ;
and (2)—the difficulty, probably equally important, of provision of
adequate after-care. This latter is strictly an economic rather than
a medical problem, and it must be admitted that many patients
who leave sanatorium with apparently excellent prospects ultimately
deteriorate on returning to their old environment. In spite of this,
sanatorium does give the sufferer a fresh opportunity, and it is hard
to see at present how it could ie replaced by any system which
would in practice be more efficient. Other forms of residential
treatment provided are in chest hospitals, and in hospitals for
advanced cases, and the question of segregating people with
advanced disease is probably as vital to the community as that of
treating the relatively early case, especially if they live in homes
in which there are a number of susceptible contacts. It is to a
great extent with the idea of preventing the spread of infection that
efforts are made to secure that persons who are too ill to workj
and who cannot be nursed at home, shall be kept for as long as
possible in hospital—as a rule the local general hospital. Since all
such hospitals are now under the central control of the London
County Council, it is possible for patients to select the one for which
they have a preference. This is often effectual in turning the balance
in favour of acceptance where treatment had been previously
refused.
The above remarks have mainly concerned adults and
pulmonary cases. Non-pulmonary, or surgical tuberculosis, is more
amenable to active treatment, though it often must be prolonged,
while children not being harassed by the adult's fear of losing work,
can always remain away till the institutional authorities are satisfied
that they have made sufficient progress to enable them safely to
return home.
In the past it had been the custom for patients undergoing
residential treatment to be asked to contribute a certain amount
towards the cost involved. The responsibility for determining the