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77.
a survey of Tuberculosis statistical returns compiled
by the sanatoria and hospitals dealing with the disease.
The problem of dealing" satisfactorily with advanced
consumptives still remains one of great difficulty. Such
cases are unsuitable for sanatoria as the prospect of a
return to "working" life is remote; and in the great
majoritv it is found that anything more than even a
temporary degree of recovery is doubtful. Institutional
treatment for these eases is therefore practically restricted
either to : —
(i) Home for Advanced Cases.
(ii) Hospital.
and as nearly all patients wish to return home, and
cannot be kept against their will, periods in such institutions
are usually of short duration.
The provision of adequate arrangements for dealing
with advanced cases is—and probably always will be—
a problem : a difficulty which is always cropping up
being the distance of institutions (i) and (ii) as above
from the patient's home and therefore inconvenient for
relatives to visit. Whereas when the patient returns
home, the difficulty in obtaining proper segregation and
hygiene, and adequate nursing attention, are disadvantages
which have to be faced.
Possibly local Homes of moderate size for advanced
cases might remove certain of the objections and it
remains to be seen whether in the future Tuberculosis
schemes under the London County Council, such
arrangements may be under consideration.
Co-oper ation of medical practitioners with the
Dispensary Medical Staff.
At a time when increasing criticism is being
directed against public health services by general practitioners
on the ground that such services are tending