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55
formed of representatives of local authorities, board of guardians, insurance committees,
and from all charitable and social work organisations in the district. Care
committees on the above lines have been in existence since the inception of the
Council's scheme for the treatment of tuberculosis and have functioned continuously
in all except two boroughs.
Thanks to the generous co-operation, as regards both personal service and
finance, of the societies associated with the work, e.g., the British Red Cross, United
Services Fund, Invalid Children's Aid Association, Charity Organisation Society, etc.,
and to devoted work on the part of other members, much good work is being done,
not only in obtaining temporary help but in other more permanent ways, such as
employment, advice as to insurance and pension questions, assistance in moving
into the country, etc. There are also a few striking instances of successful efforts
to restore families to independence.
The nature of the disease and the economic circumstances of the patients attending
a dispensary renders the sociological aspect of the tuberculosis problem of almost
paramount importance. It is not difficult for the tuberculosis officer to give or
arrange for all the medical treatment that is indicated, but to secure suitable living
and working conditions and sufficient food is a much more difficult matter. Sitting
in a consulting room and advising a winter in Egypt is one aspect of medicine, sitting
in a dispensary and advising an open window in a one-room tenement is another,
and more often than not raises the question of sufficiency of blankets. If anything
beyond such relief as can be obtained from the guardians or charitable societies is
to be attempted, the making of a considered plan for each family, with full knowledge
of the circumstances, is essential. To do this and to endeavour to carry it
out calls for the assistance of workers with special knowledge and experience and
with abundant time to devote to the work. In view of the above, one of the first
interests of the tuberculosis officer must be to see that he is given all possible information
and assistance on the social side, and this obtains to a considerable extent
throughout London.
Artificial
light
treatment
This is one of the recognised aids to institutional treatment of tuberculosis Art
and is utilised at various institutions to which patients are sent under the
Council's tuberculosis scheme for residential treatment. Enquiry has been
directed to the question whether light treatment—natural and artificial—can
be usefully extended in this country, and investigations have been carried out
by Dr. W. B. Knobel, who has made a summary of the views of leading experts in
the matter. The Council has had the benefit, moreover, of the experience of Sir
Henry Gauvain. It may reasonably be claimed that the value of such treatment
in suitable cases is proved, but that the knowledge and experience of to-day are
insufficient to define accurately the limits of the usefulness of the two forms of
" light " treatment. The information which has been collected indicates that it is
only during recent years that the use and application of artificial light has been
scientifically studied. In expert hands, as part of the treatment of lupus, the success
of artificial light treatment is regarded as incontestable. Such treatment in the
case of surgical tuberculosis is still to some extent in its experimental stage, and
whilst, in competent hands and in selected cases, it is considered to be a very
valuable factor in treatment, it must be regarded merely as an addition to other
methods of treatment. It appears not to be suitable in all types of cases of pulmonary
tuberculosis,
The question of the fullest use of artificial light for curative purposes has arisen
not only in relation to tuberculosis, but also to other physical conditions among
children in attendance at the Council's schools, and in connection with maternity
and child welfare work in the boroughs; and it may be found, after further investigation,
that additional provision for treatment by artificial light should be of a
general character, available for all types of cases met with in connection with the
education service and the health services of the central and local authorities.