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should be adequately paid, be a whole-time officer, and free from routine clerical work. After-care
committees, however, are greatly handicapped by lack of means. Many of their most effective measures
entail expense which voluntary contributions, generous as they may be, cannot fully meet. There is a
call for their greater official recognition and encouragement, and for assistance from the public purse.
At the present time there exists a considerable amount of experience and enthusiasm in connection with
the social side of the tuberculosis problem which but needs a strong lead and direction.
By some means the economic difficulties I have referred to must be met; these remedied, amelioration
in other directions would follow automatically. It should not be impossible to devise a scheme
of more generous scale of sickness benefit. I am convinced that by sensibly relieving much hardship
which now is unavoidable an increased sickness benefit would justify higher rates of contribution from
all parties concerned.
Alternative
to Poor
Law.
One would like to see also some means of official assistance other than that of the poor-law lor
what is termed the deserving poor. It is often stated that there exists no dislike to seek relief of the poorlaw,
nor indeed any cause for reluctance to do so. My experience is that the self-respecting man or
woman will make any sacrifice to maintain his independence. Many social workers inform me that they
rarely make appeal to the Guardians since in their experience it results merely in an offer to remove the
patient to the workhouse infirmary or of outdoor assistance which is altogether inadequate.
The quality of the poor-law relief varies greatly in various boroughs, exceptionally it is conceived
on generous lines.
Subsidised
employment.
Occupation.
With respect to occupation; obviously there is a limit to what after-care committees can achieve
in light but sufficiently remunerative work for consumptives. The unfit cannot compete successfully
with the sound in the open market. Herein lies the obstacle to vocational re-education except for the
few, unless provision is made for the subseqent employment of the newly trained. I can see no solution
but that work be specially organised for consumptives as a necessary part of their home treatment.
There should be conveniently situated centres at which patients could work to the limits of their physical
capacity and subject to medical supervision. The wage should be equal to the fair needs of the worker
irrespective of what he actually performs. The difference could be made up by the earnings of other
members of the family, or by a special type of sickness benefit on the lines of Dr. Varrier Jones' scheme
for Cambridgeshire. The principle of subsidising part-time labour is on trial in several places, but
it is a measure which necessitates greater funds than voluntary effort can find. The establishment of
special workshops and occupations for consumptives could not be realised without the sympathy and
co-operation of trade unions. Objection on the score of competition with sound labour might be met
by the special centres supplying exclusively the needs of local authorities and institutions under their
care and not serving the general trade. Doubtless trade unions would recognise that it is infinitely better
to encourage work even on a modest scale than to perpetuate idleness. It is true that work centres would
not meet the difficulty of bad housing. It may be said that the advantage of suitable work under good conditions
and the promise of a fair wage would be useless if at night the patient returned to an overcrowded
and insanitary dwelling. When this objection is valid the housing also must be attended to. In Paris
there are dwellings in connection with the dispensary at which consumptives,failing other means,can obtain
proper accommodation. Similar hostels exist also in America. In this country it is difficult for tuberculous
patients to obtain accommodation on account of the fear of infection ; the provision of hostels
in each borough is worth serious consideration. It may be urged that these various suggestions would
be useless in practice owing to the prejudice of the patients themselves and their dislike to advertising
themselves as suffering from tuberculosis. I feel sure that given the facilities prejudice would give way
before appreciation : everything must have a beginning.
Several of the life histories I have given refer to the common solution of economic stress arising
from the loss of the wage earner, namely the taking up of the burden of maintenance by the patient's
wife, and how this leads to the risk of neglect of home and children. The provision of creches and
day nurseries on the lines of those established for the children of women employed in munition factories
would do something to remedy this particular evil; at the same time, the continued absence from home
of the mother of the family is a measure which can be accepted only as an undesirable makeshift.
Colonies.
Colonies are urged by many as the solution of the tuberculosis problem. The usually accepted
idea of a colony is an institution which shall admit a few of the most favourable cases with a view to
completing their cure and to some extent teaching them a new occupation. A colony of this description
constitutes a valuable means of giving prolonged sanatorium treatment at a relatively low cost, and should
be a unit in any comprehensive anti-tuberculosis scheme. But institutions of this character could deal
but with a fraction of the large mass of the tuberculous population.
A more comprehensive colony scheme is conceived by Professor Sims Woodhead and Dr. VarrierJones,
among others, namely one which would offer the means of permanent settlement. It is not
designed for the compulsory segregation of patients, but as one which, by providing healthy homes,
skilled supervision, and opportunity for remunerative work alike for sick and sound, the patient and
his relations, would secure the integrity of the family unit and thus encourage a voluntary migration.
If, as is probable, all the households in a settlement were not completely self-supporting, any subsidy
granted should be regarded as a price paid for securing segregation of an infectious person, and it would