In England various existing institutions have been utilised in the treatment of tuberculosis.
1. Emphasis has already been laid on the large number of beds in workhouse infirmaries under the Poor-Law Authorities. Of the historical, as well as of the present value of this accommodation for advanced cases of tuberculosis in the poorest section of the population—which is most seriously exposed domestically to massive infection,—there can be no doubt.
But there has been prejudice against the use of this accommodation for insured persons, and such use is legally precluded; and since the passing of the National Insurance Act additional provision has been made by Public Health Authorities, and ere long the whole of the present poor-law accommodation should come under public health authorities.
2. Detached pavilions of hospitals for infectious diseases have also been employed for the treatment of tuberculosis, and experience has demonstrated that in well-conducted institutions consumptives are not exposed to risk of acquiring acute infectious diseases.
The use of these institutions favours economy of administration. It possesses the advantage that patients are, as a rule, more accessible to their relatives than in a sanatorium; and this renders patients suffering from progressive disease more willing to remain in the institution than they would otherwise be. Patients can advantageously be placed in such an institution for observation, before deciding whether prolonged treatment in a distant curative sanatorium is indicated.
Occasionally empty smallpox hospitals have also been employed for the institutional treatment of tuberculosis; but if this plan were to be generally adopted, tuberculosis work would be seriously crippled if smallpox became epidemic. The treatment of consumptives in a smallpox hospital should only be permitted for patients who could be at once transferred and who can be at once vaccinated.
General hospitals are well fitted to deal with the following classes of cases of tuberculosis:
(a) Patients admitted for observation, with a view to
diagnosis;
(b) Patients admitted to ascertain the form of treatment
best adapted for the patient’s needs;
(c) Emergency cases, e.g., haemoptysis;