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a slight drop in income is of considerable moment. Another group of patients who, after discharge
from a sanatorium, for the time being restored to health and capacity for work, often come to grief
comparatively early, is made up of those who have been advised to find employment other than that
previously engaged in. To those thus situated the search for a new means of livelihood is always a trying
and discouraging quest. It occurs, too, at a period when a man's worldly fortunes are at a low ebb,
and when he is feeling the loss of the comforts of a well-found institution.
The following is typical of many—D.C., a discharged soldier, a lavourable case recently discharged
from a sanatorium. He had made an excellent response to treatment and had been on the highest
grade of work given to the patients at the institution. He was well enough to recommence work and
anxious to do so, but since the trade he had followed previously was not considered suitable he was
looking out for a post which would command better conditions. Meanwhile, he was living at home
1 hough he could ill afford to be idle. His family consisted of himself, his wife, and one young child.
He enjoyed a better income than many similarly situated inasmuch as in place of sickness benefit of 10s.
a week he had a gratuity from the Pensions authorities of 20s. a week, this, however, was due to cease
in ten days. When I saw him he had been looking for suitable work for nearly two months but without
success. He had obviously begun to lose ground, a fact which the patient realised. The upshot was that
he went back to his old trade. Within six months he was again seeking sanatorium treatment, but by
this time his condition had much deteriorated and there was no prospect of any appreciable restoration
of capacity for work.
The discharged
soldier.
A still larger class of patients, who, their period ol sanatorium residence over, have an almost
hopeless future, is made up of those who are sent home with the report, " Improved, but not fit for
other than light employment." I imagine that in London something like 50 per cent, of all cases discharged
from a sanatorium come within this category. These patients, especially those with dependents, are
placed in the same predicament as the man whose record I have just given, but with this difference,
that being in a worse physical condition they find suitable employment still more inaccessible ; at the
same time having less resistence they are not so capable of weathering a period of relative or actual
privation. The claims upon our serious consideration of this unfortunate group of patients are urged
with great force by Dr. Varrier-Jones, for as he points out though still capable of work, they are incapable
of competing with normal labour. At the present time these patients either live at home in a state
of demoralising idleness or resume a full day's work, which is all that is open to them, until the steady
march of their disease renders them unemployable. In either case they merge ere long in the ranks of
the chronic and incurable.
The brief life histories I have given epitomise the careers of hundreds of consumptives among the
wage-earning classes. They show the manner of descent of the curable case and of the case which,
in a higher social stratum, enjoys by no means a bad prospect, into the chronic consumptive whose
progress must be progressively downward. They illustrate also how the failure to recover health completely
within a comparatively short time often leads to a fall from tolerable comfort to a state bordering
on pauperism, a condition from which it is most difficult for the working man to emerge.
The
partially
disabled
consumptive
At the risk of repetition, I quote one more history winch, as it covers the wnoie period during
which the patient was under observation, gives a more consecutive review of the downward career,
Taken from the files at my office in Insurance-street, it shows a sequence of events which has many
parallels among the records of the London Insurance Committee.
R.M., aged 36, a carman, married, family consists of his wife and three young children ; wages
35s. a week.
In May, 1916, he was found to be suffering from early tuberculosis affecting the apex of the left
lung, and was recommended for sanatorium treatment by the tuberculosis officer as one who should
do well. In the following month of June he was,admitted to a sanatorium. In October, 1916, he was
discharged. Disease apparently arrested ; health fully restored; T.B. still present in the sputum ;
fit to return to work. He at once resumed his usual employment at his former wage of 35s. a week.
A comparison between this man's income and that needed to keep a family of five persons in these days
prepares one for the way in which this case developed.
In March, 1917, the patient was reported to have had an haemoptysis, and further sanatorium
treatment was recommended. In due course he was discharged from a sanatorium, improved, but
now definitely a case of somewhat advanced disease. From this point he worked irregularly, but with
the help of extra nourishment supplied by the Insurance Committee, doubtless shared by the rest of
the family, bare existence was maintained.
In November, 1917, a social worker reported that the family was in distress.
In February, 1918, the tuberculosis officer reported that the case was " Advanced and hopeless, '
and " adequate treatment no longer possible." The man's wife was earning 25s. a week at a munition
factory, which after payment for rent, and with the addition of 5s. a week, the patient's disablement
benefit, allowed a sum of 23s. a week for the needs of the sick man, his wife, and the three children.
The housing accommodation of the family consisted of two small rooms, one of which was used by the
patient, the other being shared by the wife and the three children.
The doctor who sent this report added that the wife being away from home all day, the children and
the patient, who was practically dying, were left uncared for.
Thus. the working life of this case of early pulmonary tuberculosis,from the date he was discharged
from the sanatorium, apparently well, was iust 6 months.
Typical life
history.
The stage of chronic invalidism reached, other aspects of the consumptive problem come into view
more prominently. Hitherto, the poverty resulting from the initial disability has been considered
chiefly from the point of view of its bearing upon the prospects of the individual consumptive; it has
The chronio
and unemployable