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86
With the fear of hardship for their families while they are away and of
unemployment for themselves on their return haunting them, patients are
reluctant to give up work until physical incapacity compels them. Their
own condition gets worse and their families are exposed to increasing dangers
of infection. Bad housing conditions such as overcrowding, dark and badly
ventilated rooms, the proximity of high buildings around—factories, warehouses,
and big tenement blocks—with a resulting stagnation of air, create
an environment favourable to the spread of infection, the deterioration of
patients remaining at home, and the relapse of those returning from
sanatorium. Rehousing in municipal dwellings is frequently ruled out by the
inadequacy of the family income to meet the considerably higher rents which
must be paid, particularly when the cost of travelling expenses has to be added
in the case of workers rehoused in estates outside London. The monotony
of diet enforced by poverty and the lack of opportunities for proper recreation
increase the handicaps.
Difficulties of this kind have been particularly common during the past
year, and though a few of the worst cases have been taken up with the appropriate
authorities (the Public Assistance and the Housing Departments of the
London County Council) with some resulting amelioration of their conditions,
the general problem remains. No standard of relief which is based largely
upon the costs of a minimum diet and does not take into account the other
factors necessary for a healthy life can protect either the family concerned or
the community at large from the spread of the disease. With regard to
housing, the Sheffield scheme of assistance for infectious cases of tuberculosis
which has been in operation since 1928 has aroused considerable interest
among Tuberculosis Officers. Whilst it does not offer a complete solution, its
adoption in London would be of great assistance.
While these conditions remain, it seems to me desirable that patients
should receive a longer period of initial treatment in sanatorium as a routine.
This would do much to fortify them more strongly against a recurrence of the
disease which happens so frequently at the present time. It is true that bad
home conditions are taken into consideration by the County Council now when
the length of treatment is being decided, but very few Shoreditch patients
come home to good conditions and far too many of them have less than six
months' treatment in Sanatorium.
There has been a tendency during the past year to make increasing use
of the General Hospitals of the County Council for initial treatment. Except
in special circumstances, patients are only transferred thence to hospitals or
sanatoria outside London when they have progressed sufficiently to be up and
about without temperature for the greater part of the day. St. Leonard's
Hospital is particularly badly placed as regards environment and, though
many cases do fairly well, thanks to the rest and supervision which are the
most important features of the treatment, I am convinced that their progress