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(b) Type of Work.—1. The exact kind of work performed is not of great importance,
from the point of view of the health of the individual, provided it does not entail:—
(1) Dusty work.
(2) Work with marked exposure to the inclement weather.
(3) Very heavy manual strain.
(4) Badly ventilated workshops.
2. A satisfactory outlet for the products is essential. Accordingly the articles produced
should be those for which there is a constant and steady demand by Government and Municipal
Departments. The latter should not pay the workshop more than the market price
for such articles, but should purchase from these in preference, if the articles were of satisfactory
quality and at a competitive price. This is already done in the case of a large workshop
for mentally deficient patients by the London County Council. The work ought to be
confined to a comparatively few standard types, as it will allow the rudiments of the work
to be learned at the large sanatoria.
(c) Financial Considerations.—The results of workshops already established show that,
except under exceptional conditions, it is impossible to maintain a workshop for inefficient
workers without financial assistance. As the care of the tuberculous patient is now a function
of the State, it is unlikely that assistance from charitable sources on a large scale would
be obtainable. In view of the cry for economy it is unlikely that much assistance could be
obtained from national or local public funds.
There are, however, three official bodies who would benefit considerably by these persons
being employed.
(1) National Health Insurance Commissioners.
(2) Ministry of Labour Unemployment Department.
(3) Boards of Guardians.
Avery largenumberof tuberculouspersonsof the industrial classes are out of employment.
These are, usually, in receipt of benefits from sources No. 1 or No. 2. Which of the two, will
depend usually upon which of the two is most profitable, as it is impossible for a medical practitioner
to sign up a tuberculous patient as fit for work, unless he is willing for this to be done,
and alternatively, if a man is anxious to work, it is practically impossible to refuse to sign a
certificate of fitness in early cases, as he is probably fit for certain types of work. It should
be quite possible to work out, on actuarial basis, how much it would save these two departments
for each additional tuberculous case taken off the funds of either body.
(1) National Health Funds.—The necessary figures are available for working this out on
a large scale. The total number of tuberculous cases, in any given area, is known from the
Medical Officer of Health's register. The number of patients drawing National Health
Benefit for unfitness for tuberculosis of the lungs, is available, and so the average amount
paid out from the National Health source, per notified case of pulmonary tuberculosis is
easily ascertainable.
(2) Unemployment Funds.—A comparison between the Medical Officer of Health's
register and the employment register, over a given time, and in several selected areas would
furnish the figures saved by each tuberculous subject taken off the register.
(3) Out and Indoor Relief.—A very large proportion of the families whose bread winners
contract tuberculosis come on the rates. The figures are available, from the enquiries made
by the Boards of Guardians, and a comparison between these and the Medical Officer of
Health's Notification Register would yield a figure which would represent the saving these
bodies would make per tuberculous patient employed.
There would, therefore, be available without further cost to the community, a sum of
money per tuberculous case employed, which if mobilised from these three sources would go
far to make up the deficiency per head employed at the tuberculosis workshop.
To make these funds available legislation would, of course, be necessary, but the case
appears good enough to have an actuarial investigation made.
(d) Conduct of Workshops.—1. The amount of hours worked by any one man should be
decided on purely medical grounds by the local tuberculosis officer, whose duty it should be
to attend frequently. As long as the patient was employed at the workshop he should be
paid a minimum wage, but if he was, after trial, found to be persistently grossly inefficient
and idle he should be discharged. If his output was above the hourly normal he should be
allowed to benefit by an increase of wage. As the number of hours he was allowed to work
by the Medical Officer increased, his wage should also increase.
It is of fundamental importance that an incentive should exist for good work and good
physical progress.
2. A large rest room should be provided and the patient encouraged to rest there in
preference to going home, when he had done as many hours as allowed.
3. A substantial mid-day meal should be provided, at cost price, and the cost deducted
from the wages, whether taken or not. In this way the patient would be prevented from
neglecting himself for the benefit of his family. Patients, in this class of life, are not usually
accustomed to taking their main meal in the middle of the day, but their innate conservatism
in this matter will have become broken down by the fact that it is the routine at sanatoria.
4. No patient should be employed who has not been to a sanatorium, as he will not be
able to derive full benefit, and will kick against the restrictions, of which he does not realise
the value.