The conditions of local administration of the Sanatorium Benefit under the National Insurance Act have led to a very high proportion of consumptives being treated in sanatoria with a view to cure, who might advantageously have received educational treatment for a few weeks and then have been treated at home or at a tuberculosis dispensary. Furthermore, a large number of patients with advanced disease have been sent to sanatoria for whom treatment in a hospital was more appropriate.
Educational Work of Sanatoria
Apart from the question of cure, which with belated treatment can only be expected in a minority of cases, the sanatorium serves an important purpose, not only in restoring patients to a considerable degree of health and working capacity for a longer or shorter time, but also in educating the patients how to live and conduct themselves. A stay in a sanatorium for a short period—a month or six weeks—under doctors and nurses who realise the value of this work—would there were more of these!—secures the training of the patient on lines beneficial to his future health and enables him to obviate all danger for others.
In such a short stay in a sanatorium what may be called tuberculosis discipline can be and is acquired when the sanatorium is satisfactorily administered; and the patient thus disciplined is in a much more favorable position for securing his own welfare and that of others than the undisciplined patient, just as the soldier who has had routine drill under a competent instructor is more efficient than the untrained recruit.
The preceding remarks as to the treatment of tuberculosis in sanatoria illustrate certain well-known features in the natural history of this disease. In the majority of instances of disease recognised under present conditions we are dealing with a slowly progressing disease. This sometimes become spontaneously arrested; occasionally it may be arrested or its course delayed under medical treatment at home associated with manageable changes in domestic and industrial life. In still further instances it may be arrested by treatment in a sanatorium; while for other cases sanatorium treatment, however prolonged, is followed by only temporary improvement, and the chief benefit thus received is that of training as to mode of life, which might have been secured by a much less protracted stay in the institution, followed by measures supplementing sanatorium treatment. We have further to recognise the fact that, under present conditions of social life and medical practice, many tuberculous patients will slowly, by intermittent stages, but none the less surely, die from tuberculosis in the course of one, three or five years. Regard must be paid to this fact if our total measures for the control of tuberculosis are to be successful.
Hospital Treatment
This fact emphasizes the importance of adequate hospital treatment for all patients acutely ill or bed-ridden, who cannot be hygienically treated at home; and the importance becomes evident of exercising complete supervision over and provision for the whole of the sick life of the consumptive, whether he is trending towards complete recovery or to death.
Such complete supervision and provision necessitates further development in three directions in which beginnings have already been made:
Industrial Colonies
These are the provision of “Farm or Industrial Colonies,” the adaptation of domestic dwellings to meet the special needs of consumptives, and the more complete organization of “Care” and “After-care” arrangements.