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66
Our efforts must therefore be directed all the more
energetically in attempting to secure as early a diagnosis
as possible and immediate treatment, for it is then that
the patient stands the best possible chance of cure in
the long run, with in the meantime, a lessened prospect
of breakdown. The admission of certain chronic
cases for short periods has however a definite benefit,
as the rest, fresh air and routine under supervision tends
to encourage and re-educate, and usually gives such
patients a fresh lease of working life. The problem of
dealing satisfactorily with very advanced consumptives
remains one of much difficulty. Such cases are unsuitable
for sanatoria as the prospect of a return to working life is
remote and even a definite degree of recovery doubtful.
In dealing with this type or stage of the disease there
are 3 alternatives:—
(1) Home for advanced cases.
(2) Hospital (formerly the department of the Poor Law
Authorities).
(3) Domiciliary treatment at home, where the possibility of
disseminating the disease amongst other members
of the family has always to be faced.
It is to be hoped that in the future arrangements
for the tuberculosis service, (following the transfer to
the London County Council of the powers, etc., administered
formerly by the Poor Law Authorities) special
provision will be made for dealing with these advanced
cases.
Tuberculosis in Children. It is generally accepted
in these days that primary infection with the Tubercle
Bacillus occurs in the great majority during the first
few years of life. A severe infection in the infant
would probably cause rapidly fatal disease (in the
great majority of cases, tubercular meningitis); but a
mild tuberculization gives rise to but few symptomg, if
any, and this is probably the reason why only comparatively
few children show signs of active disease. Moreover,
repeated small infections no doubt give rise to an
individual resistance which is all to the good in later
years. The number of children on the Dispensary