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50
Matters of this kind are well worth attention; for in dealing with such a
disease as phthisis, it seems important to gain acquaintance, not only with the
material facts concerned, hut also with those mental facts, which, influencing
the patients actions, tell upon the success of administrative measures, and so
upon the spread of the infection. I have therefore tried to become familiar
with the patients' thoughts and point of view, remembering always that
actions apparently the most unreasonable and undesirable, often to their doer,
present themselves as necessary and inevitable. To find out why patients
are reluctant to enter Institutions; why, when unwilling to enter one they are
willing to enter another; why they interrupt a process of cure or relief to
return to homes obviously unsuitable; these and kindred problems are by no
means useless lines of inquiry. For if, in the development of our measures
for dealing with this disease, we ignore factors of this kind, we shall, in all
probability, find a growing tendency to concealment, a'd to tardy resort to
medical aid, which may deprive our measures of their full effect.
Among the persons notified were eight soldiers and a sailor. Four of the
soldiers dated the beginning of their illness from the Boer War. It seems a
matter for regret that the Services do not provide more generously for men
who are wrecked in health in the course of their duties
The sleeping accommodation enquiries brought to notice the risks of infection
run by persons living in lodgings shared by others. The worst case was one
in which a consumptive occupied a bed during the night and another man the
same bed during the day, both occupying it on Sunday nights.
When a family has seemed unduly crowded, though not technically " overcrowded,"
I have often advised sending a daughter to domestic service. The
Metropolitan Association for Befriending Young Servants is very kindly
willing to help and advise in such cases. There does not seem to be any
similar manner of dealing with the boys of affected families. Help in this
direction would, in carefully selected cases, be of great value.
In the choice of occupations for patients or for persons susceptible to the
disease, it does not seem sufficient to consider merely the outdoor nature of the
occupation. A printer, who, with the idea of improving his healtb, became a
motor omnibus conductor, grew worse rapidly. In several cases carmen and
porters engaged in open air work speak of strains and inj uries from carrying
heavy weights as having contributed to their illness.
It sometimes seems that the disease has a tendency to recur in particular
houses or groups of houses, but there is 110 clear indication of direct connection
between the cases. In the one instance in which a second case was
removed from a room, the second patient was stated to be in an advanced
state of the disease before coming to live in the room.
The Children's Care Committees attached to the Schools of the London
County Council have been helpful in placing on the list of dinner-receiving
children members of consumptive families to whom the danger of infection
wras greater by reason of their underfed condition. The teachers of the Schools
have also been most kind in keeping under observation children for whom I
have requested special attention.