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been shown how it discounts the hopes of his permanent recovery, and may lead to a state of impoverishment
which renders home treatment quite ineffective.
It is not suggested that the large community of chronic consumptives is made up of those who,
at one time, were amenable to treatment. Many, of course, are past hope of sensible amelioration
when they first come under observation. In London, most of these cases receive a short term of institutional
treatment, and on discharge, at once enter the ranks of the unemployable, and, unless the
family can adjust itself to the loss of the principal wage-earner, into a life of poverty.
In these latter phases, the working career of the patient, for all practical purposes, is finished.
He may indeed have some months or years of life before him, during which he will work fitfully, for
the most part during the summer months. Still the end has come within measurable distance, and the
most pressing practical question has become that of safeguarding the patient's family from infection
and impoverishment.
The conditions under which these cases of advanced disease live are often profoundly unsatisfactory;
the patient cannot be cared for properly, neither can adequate precautions be taken to prevent his
being a source of infection. Almost invariably the sole income of these individuals is their disablement
benefit of 5s. a week. It is surprising how many single men and women contrive to live upon I his
small sum, eked out with occasional doles, grants of food, or other slight assistance.
The following, for instance, is by no means exceptional—Miss F., aged 40, formerly a machinist;
was under treatment in a sanatorium during 1914, 1915 and 1916. Disease now advanced, but the
patient is still able to be up and about. For a long time her income has consisted of her benefit of
5s. weekly, and an allowance of 5s. a week from her former employers. Of this, she pays 4s. a week
for the rent of her room, leaving her 6s. a week for all her requirements. Her doctor asks for extra
food for her, as she cannot afford the necessaries of life ; she will not entertain the idea of entering the
infirmary
Poverty in
advanced
cases.
Patients suffering from advanced disease who live with their families are frequently a burden to
them, financially speaking, since their contribution of 5s. a week does not enable them to pay their
way. As an example, the following came to my notice a few days ago as the result of following up
a request for a grant of food—
The household comprises six persons, five adults and one child of 10 years. Two of the adults
are suffering from advanced consumption. After payment of rent, the total income of the household
amounts to 36s. 6d. a week, including the disablement benefit of one of the patients, thus leaving 6s.
a week per head for expenses under all other heads. The doctor reports that the parents of the sick
persons will not agree to their removal, though this course would greatly relieve the situation. He adds
that the two consumptives cannot be tended properly, and that the household is miserably poor.
Sometimes, a whole family is found to be living practically on the disablement benefit of the
former wage-earner, with the help of a grant of extra nourishment supplied by the Insurance Committee.
For example—
J.B., a widower, with 7 children, of whom one is a soldier and the others still living at home.
Income, 5s. a week benefit, and 10s. a week from the soldier son. Rent lis. a week. The whole family
are living upon the balance of 4s. a week, supplemented by a grant of food from the Insurance Committee.
In such a case the grant of food to the patient is not serving a useful purpose ; from the patient's point
of view, it enables him to be independent of the poor law, but at the cost of the interests of a young
family.
It is in households of this character that one sees an association of conditions which are calculated
to make for the spread of tuberculosis. Opportunity for massive infection in the shape of a highly
infectious invalid; reduced resistance, consequent upon malnutrition of those with whom he lives,
and overcrowding which permits of the continued exposure to infection of those who, for the time
being at least, are most susceptible to invasion by the tubercle bacillus.
Housing.
I have considered the social life of the consumptive mainly from its financial aspect; incidentally,
however, I have touched on two other closely associated factors, housing and employment. Both of
these play a large part in the lack of success which attends our efforts to cure tuberculosis.
Several of the life histories I have quoted instance the difficulties which arise on these heads.
They have brought out the fact that there are scarcely any avenues of suitable employment open to
a large number of patients who are capable of work and of ultimate recovery, and that for want of
other means of gaining a livelihood many resume work under conditions which must result inevitably
in the speedy loss of the benefit conferred by treatment in a sanatorium.
With respect to housing; another factor, the importance of which cannot be exaggerated. When
one bears in mind the needs of the tuberculous in regard to air, and reflects that throughout England
and Wales one out of eight families live in dwellings comprising one or two rooms, the significance of
the housing question to the treatment of tuberculosis can readily be appreciated. The fact that
tuberculosis officers classify the home conditions of patients in their areas on the basis of the number
of persons who share the same room or the same bed with the invalid is an indication of the gravity
of the handicap arising from overcrowding. There is no need to labour this fact. I will but cite
one case as an example of what the consumptive and those who would help him often have to contend
against.