Public health and insurance: American addresses - Sir Arthur Newsholme

In a large proportion of cases, the patient on leaving the sanatorium is unable at once to embark on full work without risk of early relapse, or to refrain from this without endangering his nutrition and that of his family. His work, furthermore, may be unsuitable for a consumptive.

This has led to many tentative efforts to train the consumptive in a suitable occupation while under sanatorium treatment, or in an industrial colony which should preferably be attached to or in close communication with a sanatorium, in order that the patient may continue under skilled medical supervision. The graduated labour which forms part of the routine method of treatment in many sanatoria can be made a preparatory stage in this industrial training. The training may be made to merge into the pursuit of an actual livelihood; and then the sanatorium becomes an industrial colony. Market gardening, pig-keeping, forestry, and other occupations may be thus pursued for protracted periods, if the patients are suitably selected. The ex-patients continue to live under protected conditions, earning part at least of their livelihood. Attempts in this direction are not likely to have wide success unless the patient is re-instated in his family; and the most promising efforts are those which install the ex-consumptive with his family in a cottage near a sanatorium, where he can remain under partial medical supervision, while engaged in his daily work. It remains to be seen to what extent such arrangements are practicable on a considerable scale, and the experiments now being made will be watched with interest.

Special Dwellings and Help in Support

An alternative to the “colony” proposal, which will probably be found practicable in a much larger number of cases is to arrange for the ex-patient to be housed at his home under special conditions and for his work to be graduated according to his physical condition, assistance being given by way of payment of rent, or otherwise to ensure that the patient and his family live under satisfactory conditions. Proposals have been made by Dr. Chapman in a report to the English Local Government Board that in connection with new housing schemes a certain proportion of the houses erected should have rooms providing free perflation of air reserved for consumptive patients. If with this is combined the assistance indicated above, the risk of the ex-patient relapsing will be materially reduced, and the risk of other members of the family becoming consumptive may be obviated.

Whatever methods are employed, the principle already enunciated must be maintained that the patient in his own interest and in that of his family must be the subject of uninterrupted care and supervision.

In securing this end Care Committees play a valuable part. Owing to the war their development has been retarded; but a local scheme for such supervision and assistance as the members or agents of a Care Committee can give forms an essential part of a complete tuberculosis scheme.

These Committees are formed of non-official persons, inasmuch as a large share of their work is at present beyond the scope of official possibilities, outside the poor-law organization; they can help,

(a) in obtaining appropriate work for the ex-patients;

(b) in supplementing his wages;