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After-care
TUBERCLE THE
T H E J O U R N A L OF BRITISH T U B E R C U L O S I S A S S O C I A T I O N
A STAPLES
®
PUBLICATION
Annual Subscription U.K. 40s. post free Annual Subscription U.S.A. $6. post free
Single Cop)' U.K. :is. 6d. ; (:Is. 7½d. post free) Single Copy U,S.A. (75 cents post free)
A f t e r-care In these columns we have often drawn attention to the importance of the paramedical services i n helping to eradicate tuberculosis. The trend of medical training, the new specific remedies, the outlook engendered by Regional Boards have all tended to produce a new type of chest physician, a man whose interests are overwhelmingly clinical, a cavity closer or resector. T h e best of the older type tried to see the tuberculosis problem as a whole against the background of changing social conditions and habits, its incidence and mortality influenced by the personal frustrations and miseries of the people of their districts. It is against this background that tile paramedical services have their parts to play: and there are in the main two parts. In the first the local authorities strive to raise the standard of health by rehousing, by educating and by attending to sanitary conditions and some would say that this in the past has proved the most potent influence in the improvemen~ of public health. In the second they attempt to limit the damage done when the health of individuals breaks down and it is here that the local authorities have powers and duties under Section 28 of the NHS Act in dealing with tuberculosis. These powers and duties are becoming increasingly important for there is little doubt that our patients are living longer, a proportion of them permanent respiratory cripples and some of them constantly or intermittently infectious. All these patients stand in need, more perhaps than they are aware, of intelligent help and guidance in
their lives, quite apart from the relatively simple supervision required by their tuberculous lesions. Local authorities have long acknowledged their obligations in this matter and have appointed Health Visitors, either specifically for tuberculous patients or else to visit them along with all their other patients. With the coming of the tuberculosis allowances during the war it became clear that there was an aspect of after-care which the Health Visitor could not deal with and some authorities appointed Almoners to chest clinics while a little later occupational therapists were added to the staff. The duties of the occupational therapists are distinct enough but there is much confusion over the line which divides the duties of the Health Visitor and the Almoner. And in many authorities it is still thought that the Visitor can cover all the after-care that is needed in tuberculosis. Only those physicians who have worked with Almoners can tell how invaluable is their contribution to the work of the clinic. It is difficult to recall how one managed before they were appointed. Briefly the Visitor is the family guide in health education while the Almoner works in the domain of sociology and there is more than enough for both to do. It seems to us that many local authorities are not aware of their opportunities here and that in consequence many tuberculous families are suffering unnecessarily. The alleviation of this suffering would lead to a reduction in mortality as surely as day succeeds night.
T H E J O U R N A L OF BRITISH T U B E R C U L O S I S A S S O C I A T I O N
A STAPLES
®
PUBLICATION
Annual Subscription U.K. 40s. post free Annual Subscription U.S.A. $6. post free
Single Cop)' U.K. :is. 6d. ; (:Is. 7½d. post free) Single Copy U,S.A. (75 cents post free)
A f t e r-care In these columns we have often drawn attention to the importance of the paramedical services i n helping to eradicate tuberculosis. The trend of medical training, the new specific remedies, the outlook engendered by Regional Boards have all tended to produce a new type of chest physician, a man whose interests are overwhelmingly clinical, a cavity closer or resector. T h e best of the older type tried to see the tuberculosis problem as a whole against the background of changing social conditions and habits, its incidence and mortality influenced by the personal frustrations and miseries of the people of their districts. It is against this background that tile paramedical services have their parts to play: and there are in the main two parts. In the first the local authorities strive to raise the standard of health by rehousing, by educating and by attending to sanitary conditions and some would say that this in the past has proved the most potent influence in the improvemen~ of public health. In the second they attempt to limit the damage done when the health of individuals breaks down and it is here that the local authorities have powers and duties under Section 28 of the NHS Act in dealing with tuberculosis. These powers and duties are becoming increasingly important for there is little doubt that our patients are living longer, a proportion of them permanent respiratory cripples and some of them constantly or intermittently infectious. All these patients stand in need, more perhaps than they are aware, of intelligent help and guidance in
their lives, quite apart from the relatively simple supervision required by their tuberculous lesions. Local authorities have long acknowledged their obligations in this matter and have appointed Health Visitors, either specifically for tuberculous patients or else to visit them along with all their other patients. With the coming of the tuberculosis allowances during the war it became clear that there was an aspect of after-care which the Health Visitor could not deal with and some authorities appointed Almoners to chest clinics while a little later occupational therapists were added to the staff. The duties of the occupational therapists are distinct enough but there is much confusion over the line which divides the duties of the Health Visitor and the Almoner. And in many authorities it is still thought that the Visitor can cover all the after-care that is needed in tuberculosis. Only those physicians who have worked with Almoners can tell how invaluable is their contribution to the work of the clinic. It is difficult to recall how one managed before they were appointed. Briefly the Visitor is the family guide in health education while the Almoner works in the domain of sociology and there is more than enough for both to do. It seems to us that many local authorities are not aware of their opportunities here and that in consequence many tuberculous families are suffering unnecessarily. The alleviation of this suffering would lead to a reduction in mortality as surely as day succeeds night.