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a week for rent, leaving a balance of only 4s. 6d. a week. This patient elected not to go away and was
recommended for domiciliary treatment. At this juncture his situation at home was relieved somewhat
by the following expedients. Two children were sent to the care of relatives, and his wife obtained
work at a wage of 24s. 6d. a week. In her absence there was no one at home to look after the sick man
and the other three children; moreover, for the maintenance of this family of five persons, which included
a consumptive, there was even now, after payment of rent, less than 20s. per week, obviously an altogether
inadequate amount.
Cases of this character come to my notice daily. I make a practice of enquiring into all cases of
refusal to enter a sanatorium, and my experience is that while some cover an excuse to stay at home,
the majority result from genuine difficulty—I refer more especially to civilians. Discharged sailors
and soldiers usually plead the disinclination for further institutional life and discipline.
There is no doubt that anxiety as to the support of dependants determines many a wage earner to
ignore the first symptoms of consumption and to refuse sanatorium treatment even when the nature
of his disease has been revealed to him. Thus it comes about that what should be the inestimable
value of early diagnosis disappears, and the favourable case is lost to be met with again later as one
with scant hope of recovery.
It happens not infrequently that the fall in the amount of sickness benefit to 5s. a week, which
takes place after 26 weeks, accentuates financial embarrassment. This is more likely to be the case
when restoration to a capacity for work is but slow, or when there has been much delay in the patient's
admission to a sanatorium. There are few more potent sources of hardship to a patient and of dissatisfaction
to his medical attendant than a long " waiting list " for institutional treatment.
During
residence.
Apart from proving an obstacle to early treatment, the economic difficulty is a common cause
of unrest on the part of the patient while in a sanatorium, and often leads to the request of discharge
when an interruption in serious treatment is most undesirable. The following is characteristic—
A.W., aged 28, a taxi-driver, earning usually 45s. a week. Found to be consumptive, he was
admitted to a sanatorium. After a probationary period of six weeks he was recommended for an extension
of stay but declined it. An interview then elicited the following information which subsequent inquiry
confirmed—For the support of his wife and family of three young children he had only his sickness
benefit of 10s. a week, of which 5s. was earmarked for rent. He had borrowed money to tide him over
the earlier weeks of his illness, and was not prepared to incur further debt. Finding no way out of his
dilemma he left the sanatorium and resumed a full day's work. Within nine months he was bedridden
and a hopeless invalid. So much for the financial factor as it affects the more initial phases of the career
of the consumptive worker.
In the case of the patient who has just returned home from a sanatorium the problem of ways and
means is often no less acute. If, happily, the disease has been of slight severity and response to treatment
prompt and satisfactory, if further, the patient's occupation be reasonably suitable and his income sufficient,
the outlook is promising. Such an association of favourable factors is the exception rather than
the rule. More commonly the situation is something as follows—
The patient returns home greatly improved, in his own opinion quite well, and is reported by the
sanatorium doctor to be fit to start work. Actually the treatment received, though sufficing to bring
about a complete disappearance of all symptoms of active disease, has not been of long enough duration
to secure any true arrest of the morbid process, far less cure. Further progress and ultimate recovery
depend entirely upon the ability to carry on the essentials of treatment. Above all things this implies
something more than a bare living wage. This period is a critical one and full of hazard for the convalescent
consumptive.
After
discharge.
Though he be possessed of character and be industrious, and his wife also, his social conditions
often predestine him to failure. The following history records a common experience—
A.B., aged 35, insurance agent; stated by his employers to be steady and reliable. Admitted to
a sanatorium as a patient who should make a complete recovery, he had been discharged nine months
before he came to my notice, with the report "Disease arrested," " fit to resume work." He had
subsequently worked continuously for some eight months without any apparent depreciation of health,
but latterly symptoms of tuberculosis had recurred. Examination at this date revealed an extension
of the disease of such a character that save for immediate and prolonged treatment, the patient's
expectation of life could not be reckoned as much over twelve months. Although he admitted being
no longer fit for his daily duty, the patient would not even consider the suggestion of his giving up work.
He pointed out that to do so would, for a second time, plunge his family into poverty.
He had a wife, and three children, all under 10 years. His salary was at his pre-war rate of 35s.
a week ; of this he paid 8s. 6d. a week for rent and Is. 4d. a week for insurance, and other subscriptions,
leaving some 25s. a week for the maintenance of the whole family. The patient's wife said that she
found it quite impossible to provide her husband and children with enough food ; moreover, she had been
handicapped by a debt incurred during her husband's absence at the sanatorium. The patient remained
at work. The sequel is not difficult to anticipate; the man steadily became worse until he was compelled
to give in. There followed a brief but hopeless effort on the part of the wife to keep the home together,
terminated by the death of the patient and the break-up of the family.
It is to be noted that this patient returned to his usual employment and to his customary wage.
What he earned, however, though perhaps just adequate under peace conditions, was such that under
existing circumstances a proper standard of living could not be maintained.
Difficulty of
inadequate
wage.
One sees many patients, who, as the one just instanced, have resumed work but at an inadequate
wage, in view of their particular requirements. Commonly this is due to having undertaken "light"
work ; for the most part this is unskilled, and in consequence, ill paid. To the working classes even