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7
of the population, however, are showing a greater decline than
others; among the 15-30 age period in females the decline has
apparently ceased. The causes for the behaviour of Tuberculosis
are imperfectly understood, in spite of the great amount of research
which has been and is being carried out. Whether the Tuberculosis
Schemes of local authorities have exerted an influence in bringing
about the decline, or whether it is merely a variation in the cyclic
course of a disease in which the cycle covers a very long period of
years, is impossible with our present knowledge, to ascertain with
any degree of certainty. There is, however, very little doubt, that
the activities of sanitary authorities, in connection with the milk
supply, has lessened the amount of non-pulmonary Tuberculosis.
One of the most difficult aspects of Tuberculosis is its
chronicity. This is more a social problem than a medical. The
rehabilitation of a Tuberculous patient after a long period of sanatorium
treatment is a difficult matter. In many instances the
patient, although fit for productive work if the work can be done
on free and easy lines, breaks down when thrown into the competitive
work of every day business. In others the patient returns
with the disease quiescent from the Sanatorium back to the same
condition which brought about his initial breakdown ; naturally
before very long another breakdown happens. It is not the early
Sanatorium case nor the advanced bed-ridden hospital case who
cause the difficulties, but the case in between who is unfit for full
work under industrial conditions, but fit for sheltered work; who
is capable of mixing freely with his fellowmen, but unable to compete
with them on level terms. Until some widespread scheme is
adopted, possibly extensions or modification of the present, very
limited colony system, throughout the country, there will be little
hope of the final eradication of Tuberculosis. Such schemes would
perforce, be expensive, but Tuberculosis is a costly disease and its
eradication would be an ultimate saving; unfortunately perhaps the
visible saving effected would be a deferred one and would not, to
any great degree, benefit the present generation.
The Occupation work organised in the Cheam Sanatorium and
also for patients in their homes on returning from the Sanatorium
has had a busy and successful year. The object of this scheme is
primarily therapeutic. There is perhaps nothing more demoralising
mentally and bodily, than months of enforced idleness. If a
patient can occupy the time in making useful and artistic articles
it is of distinct benefit in the treatment. All the home workers
are kept under supervision and visited from time to time by the