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though working equally hard, can more easily take a few hours to go to the out
patients' department of a hospital, as she has not to obtain an employer's leave
to absent herself from work. She may be under the impression that she is suffering
from weakness, indigestion, or other slight ailment, but, the true nature of the illness
is often detected at the hospital, and thus is explained probably the reason, that a
greater proportion of women than of men enter the sanatorium in an early stage
of the disease.
Early cases may be detected sooner if the " Tuberculosis Dispensary," system
becomes more in vogue. Such a dispensary has been in existence for 21 years in
Edinburgh, and one has been established in Paddington for the last 18 months or
2 years. Another one is shortly to be started in the Borough of Stepney. It is
claimed that this system offers the best method of dealing with the consumption
problem by the provision of:—
(1) Effective curative treatment.
(2) Effective method of prevention.
(3) Effective machinery for dealing with the problem as a whole.
The physician of a Tuberculosis Dispensary visits the patients in their own homes
and by personal influence insures that his instructions are carried out, while at the
same time he obtains first hand information as to the conditions of home and other
environments which have produced the disease. These advantages in the prevention
and early diagnosis of consumption are obvious. The doctor having thus become
acquainted with members of the family, finds it easy to persuade them to submit
to examination. Thus, a great number of early cases are discovered which may be
arrested in good time. These " contact " cases would, in the absence of a system
of home visitation, possibly remain undiscovered until too late. The domiciliary
visit has often the further advantage of discovering an active focus of infection in
the person of a chronic consumptive not under any medical treatment. I do not
know of a better system by which early cases of consumption can be discovered.
Having discovered early cases we have still two great difficulties, first—as I have
already stated—the pecuniary one ; and secondly, the want of accommodation.
The working-man may not have to pay for sanatorium treatment, but he may have
to wait such a long time for a vacancy in the sanatorium where admission is gained
by a subscriber's letter, that, when at length he is admitted, he is no longer an
'' early case." The waiting period may be anything from three to four months,
or even longer in such sanatoria.
There is also the difficulty of making provision for those dependent upon the
consumptive, while he is unable to work.