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114
up, and they clear up without any other treatment than a little care for
the health of the patient.
Here, I think, is one reason of conflicting Sanatorium reports; and
although it is doubtful if Dr. Stock's report can be taken as expressing
the true results of Sanatorium treatment, I think that there is no doubt
that many of the A1 cases entering Sanatoria would do as well and get
cured as satisfactorily outside.
At the same time, if an A1 case exhibits i any signs of Toxaemia or
of failure of resistance, there can be little doubt but Sanatorium treatment
or Convalescent treatment is of use.
In Dispensary work and amongst the poorer classes the economic
factor is the principal one in the etiology of the disease.
In discussing the matter with other Tuberculosis Officers I have
raised the question as to how many cases seen and diagnosed as nontuberculous
are afterwards found to have developed tuberculosis, and we
have agreed the extreme rarity with which this occurs, and this in spite
of the large number of contacts examined.
I think it is fair to assume that when a case does fail in resistance
or becomes massively infected the progress of the disease is rapid, and
that this accounts to some extent for late notification. From the figures
at the Dispensary it would seem that much of the money spent on Sanatorium
benefit is completely wasted. This arises, I think, from the short
period of average benefit, and from the economic factor that the
patient faces on return; either having to work or having less money—
often both.
The best method of expending money available to the best advantage
is difficult to determine, and the mere fact of centralisation makes the
machine so cumbersome that no tentative scheme is possible for trial.
The effect of breaking a habit of work always tells on return to
work. One finds this in other diseases; it is common to find persons with
heart disease working at arduous occupations and keeping well; but if
they take a prolonged rest and then go back to work of the same type it
is usual for their hearts to fail; the same occurs in the very busy, healthy
individual after a holiday; he finds his work, for a time, much more
tiring; so that if only 3 months is to be given, which cannot help to cure
the disease, are we doing more harm than good ? New schemes naturally