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" Two children whose condition was complicated with commencing scoliosis
have been greatly benefited by appropriate treatment, and a number of the children
who at one time suffered from adenoids have also received special exercises and
advice regarding their breathing "
During 1923 Dr. Bardswell has investigated the after histories of adult tuberculous
patients in the County of London who received institutional treatment during
the year 1918. The results of these enquiries may be summarised as follows:—
Enquiry into the careers of 2,987 cases confirms the impressions formed by
many experienced observers, as to the usefulness of the sanatorium in the treatment
of tuberculosis in its initial stages, and of its ineffectiveness when the disease is wellestablished.
Dr. Bardswell's
report
on after
histories of
adult tuberculous
patients.
The cases of pulmonary tuberculosis treated during 1918 were made up of 47
per cent. early cases, 29 per cent. of moderately advanced cases, and 24 per cent. of
far advanced cases. Many of the last-named group were in the terminal phases of
the disease, for whom temporary alleviation of symptoms was all that could be hoped
From the point of view of treatment and recovery, interest centres on the groups of
early and moderately advanced cases. The investigation showed that in July, 1923,
some four to five years subsequent to their sanatorium treatment, 85 per cent. of
the early cases, and 39.9 per cent of the moderately advanced cases were alive and
the remaining 15 per cent. of early cases and 60.1 per cent. of moderately advanced
cases were dead. The group of far advanced cases, as was anticipated, showed a
heavy death-rate, only 4.5 per cent. having survived. The comparable figures for
1914 were—(a) early cases 26 per cent., (b) moderately advanced cases 53 per cent.
and (c) far advanced cases 21 per cent.
The marked increase of the percentage of early cases dealt with in 1918, as
compared with 1914. is encouraging. A higher level of medical skill and attention
in 1918 may account for some of the improvement. On the other hand, errors of
diagnosis, especially among the ex-service men, almost certainly contribute to the good
proportion of early cases. The guiding principle has been to give ex-service men the
benefit of any doubt, with the result that many cases of obsolete tuberculosis and of
non-pulmonary lung disease have been notified as active tuberculosis. In consequence,
some fall in the percentage of early cases may be expected in subsequent
years. There appears to be no doubt that the patient's home environment, his
housing, work, habits, temperament, and standard of living, determine the consumptive's
future to a much greater degree than does his period of sanatorium
treatment. Under the conditions to which many, indeed the majority, of London
patients return on leaving a sanatorium, well-established tuberculous disease of the
lungs is rarely to be cured. Successfully to withstand conditions so unfavourable,
tuberculosis must needs be arrested more completely than is possible during a stay
of a few months in a sanatorium. A year's continued sanatorium treatment might
make more difference. Even then, in many cases, one would expect bad home
conditions to be the decisive factor in ultimate failure.
The question is often asked : Can nothing more be done to improve the prospects
of the case of moderately advanced disease ? Is a mortality of some 70 per cent. within
four years to be accepted as inevitable ? The pensioned ex-service man throws some
light upon this point. The ex-service man, as compared with the civilian, has
enjoyed exceptional advantages. No limit has been put to his institutional treatment.
Most of the men have had repeated and prolonged periods of treatment,
terminated only at their own request or on the recommendation of medical superintendents
of sanatoria. At the same time, financial worries and anxiety about dependents,
both during and after treatment, which may be a source of failure in the
treatment of the civil population, are eliminated by the receipt of pensions and
allowances. The ex-service man, in short, has had a well endowed scheme of alter
care. One would expect, therefore, to find that the ex-soldier has done better than