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patient cannot be expected—as he so often has to do—to compete
in the open market, but this does not mean that a tuberculous
subject, following a full course of institutional treatment, is not
employable. Many relapse cases that we have to encounter would
be eliminated if an adequate rehabilitation system was established
as part of the tuberculosis scheme. The prospects of the tuberculous
patient require earnest consideration, and Heaf's scheme
for the formation of a National Board comprising medical and
industrial experts to found industrial settlements throughout the
counrty for the tuberculous and to act as a labour bureau, might
in the long run, prove—through an increased sense of security
—as important in preventing relapse in pulmonary tuberculosis,
as the closure of cavities. As Sir James Kingston Fowler used
to say, "Hope and work produce vitality." There is much to be
said for the wisdom of these words.
An obvious necessity both for the patient with active tuberculosis
and for those who have returned from sanatoria, is separate
and airy sleeping quarters.
Sheffield, Wakefield and Middlesborough each have special
housing schemes, which might well serve as an example for us.
The present compulsory reporting on housing conditions is of no
appreciable value unless it leads to action.
Environmental Factors in Care and After-Care.
Recognising the great importance of these factors, the absence
of which has often been responsible for much of the disease we
meet, the greatest stress is laid on this aspect, both in treatment
at the Sanatorium and in the follow-up and subsequent care of
cases at the Chest Clinic. The close co-operation of the medical,
nursing and clerical staff in this connection is of the utmost value,
and the work of the After-Care Committee speaks for itself.
It should be a first principle with tuberculosis authorities
that no patient should ever return to conditions identical to those
on which his breakdown originally took place.
The ex-sanatorium patient needs light work, short hours and
healthy conditions. It is in only a very limited number of individual
cases that patients can find such work in the ordinary
labour market or through the personal efforts of members of care
committees.