- Email: [email protected]
CONTROL OF VENEREAL DISEASES.
450
NOTES FROM INDIA.-CONTROL OF VENEREAL DISEASES.
NOTES FROM INDIA. (FROM A REGULAR CORRESPONDENT.) - B’M<<6 Pastezcr Institute. AT the Burma Pasteur Institute during 1918-19 595 persons sought advice as compared with 426 in the previous year. The number of persons bitten by animals of proved taint who submitted to the full course of treatment fell from 183 in the previous year to 105 in the year under review. There were no deaths during the year from hydrophobia amongst those who submitted to treatment, whilst at least four deaths from this cause are reported to have occurred amongst 34 individuals who declined to undergo treatment.
Influenza Reorudescenoe. The following communique has been issued by the Government of India :Outbreaks of influenza are reported from Bombay, Calcutta., Rangoon, and Madras. These outbreaks do not (save in the case of Bombay) appear to have attained serious dimensions. Nevertheless, they coincide in time with the
effect from Dec. lst, 1918.1 This action of Government will help to allay the apprehension created by the grave state of affairs to which we have repeatedly directed attention, and it will also no doubt afford some encouragement to overworked officers of the I.M.S. who are almost at breaking point. There is no disguising the fact that the present position is well nigh desperate. More than 60 per cent. of the LM.S. civil officers are still in military employ, and military employments in India are increasing, not diminishing. India itself has been ransacked for doctors to make good the deficiency and the only hope now lies in making the terms of service so attractive that the necessary number of men will be forthcoming from the medical schools at home. We are glad to learn that the Government of India recognise that the matter is one of extreme urgency and are apparently determined to put it right. But it will not be so easy as it would have been before the war to obtain recruits by improving the conditions of the Service. There probably never was a time, indeed, when the opportunities open to medical men at home were so favourable as they are at present. This is an additional reason why there should not be a moment’s unnecessary delay in taking the definite action which the gravity of the situation demands.
War GratMity of the Indian Army. the British scale, the Government of India preliminary outbreaks of last year, and though there is announces that it has been decided to issue to regular officers no reason to an same of the I present apprehend epidemic the Indian Army, Indian Medical Service, and of the proportions the measure of immunity conferred on any I in individual by a previous attack is uncertain. Accordingly I, British garrison in India, and to departmental officers with the following steps have, among others, been taken as a honorary rank of the Indian Unattached List a gratuity for war service on the same conditions generally of those preliminary precaution. The Government of India have suggested to Maritime announced for officers of the British Army in Army Orders IV., Governments the taking of power to notify by rule under dated June 7th, 1919. The gratuity will be payable in the Indian Ports Act ship-borne cases of pneumonia, and the case of officers still on the active list on discretionary power similarly to deal with ship-borne cases 1919, or the termination of war as defined August 4th, by statutory of violent influenza. They have requested early intimation of all outbreaks in order that timely warning may be given authority, whichever is earlier. It is not payable to any Officers who officer commissioned after February, 1919. to the authorities in neighbouring areas and to the public. Stocks of anti-influenza vaccine are being made ready for have retired and the legal representatives of officers who early transfer to centres of infection. Surgeons and adminis- have died or been killed in the war should apply for a form trative medical officers are being invited to indent for of claim to the Secretary, Military Department, India Office, supplies to be ready on the spot in case of emergency. 1. S.W. London, A specialist has been deputed to Bombay to deal with the New Medical Scholarship. situation. Lieutenant-Colonel -W. D. Smith, commandant of the The Sanitary Commissioner with the Government of India has distributed widely a leaflet dealing with influenza and Madras Guards, has presented a scholarship valued at the course that should be taken in case of an outbreak. This Rs.1200 to the Madras Medical College for students in has been communicated to the press. He has specially recomand drugs. chemistry mended the use of an aniline nasal douche as an effective Calcutta f’nh’ersity G’orramissioa prophylactic. Though there is no immediate cause for alarm, it has been A summary of the report of the Commission has been thought advisable to inform the public of these new outbreaks published. It concludes as follows :in order that the necessary precautions may be taken and, Wedesire to make it clear that certain reforms in the should the disease show signs of further extension, other University of Calcutta ought not to be postponed whatever communiques will from time to time be issued. scheme be adopted-namely, the provision of further resiExtra medical precautions have been taken at Howrah dential accommodation, the provision of a teachers’ training station to meet returning pilgrims from Puri. It has been department, the provision of additional accommodation for ascertained that influenza is raging in epidemic form at teaching, and the provision of measures for supervising and Puri. At Howrah doctors treated 40 cases of influenza and improving the health of the students.. August 10th. 1 case of cholera.
at
Issuable
on
___________________
infant Welfare Exhibition at Delhi. maternity and infant welfare exhibition will be held in Delhi in February, 1920. It will be reserved for women on certain days, but will be open to men at other times. The proper care of mothers and babies will be shown by means of model exhibits, leaflets, lectures, pictures, magic-lautern The exhibition will be arranged in the following slides, &c. sections : pre-maternity, maternity, infant welfare, childhood, domestic hygiene, and sanitation, first aid and home nursing. A baby show will also be held. The whole will be under the patronage of Lady Chelmsford. It is hoped A
CONTROL OF VENEREAL DISEASES. Early Preventi1.’e Treatment and the N. O. C. v.n. A RECENT deputation from the National Council for Combating Venereal Diseases, led by Sir Malcolm Morris, was received by the Public Health Committee of the London County Council. Its object was to urge the County Council to make provision, through its scheme for the diagnosis and treatment of venereal diseases in London, for early preventive treatment-that is to say, "treatment at an approved centre within a short time after exposure to possible infection." The question also arose of treatment before exposure, and of the alleged objections to such treatment on the side of public morals. It was stated by the deputation that for early treatment to be effectual in the prevention of syphilis, it must be initiated within six hours after exposure to risk. It therefore follows that it would be necessary to institute a very large number of early treatment centres, accessible at all hours of the night and day. The Public Health Committee stated that with one exception the committees of all the London hospitals at which venereal clinics were in operation had definitely expressed the opinion that it would
that this exhibition may be the forerunner of many others both in Delhi and in other cities of India, and that it may lead to a great improvement in the condition of childbirth and the welfare of young children. Shortage of -11-redical Officers. A leading Indian journal says :We understand that the Government of India are drawing the attention of the Secretary of State to the extremely serious shortage of regular officers of the Indian Medical Service and urging recruitment of a large number of European officers for enrolment permanently. The Government of India have also proposed that certain measures recommended by the Medical Services Committee as likely to increase the attractions of the I.M.S. should be announced We further understand that the in England at once. 1 The new rates of pay for the military and civilian sides of the Indian increased rates of pay for the I.M.S. in civil employment will Medical Service were given in the Students’ Number of THE LANCET, be announced very shortly, and that these rates will takeAugust 30th, 1919, p. 398.
TUBERCULOSIS. call for
be impossible for them to introduce early preventive treatment on these lines. The National Council has made inquiry of medical officers of health of certain provincial towns, but apparently no steps have been taken to provide opportunities for such treatment. The Public Health Committee came to the considered conclusion that quite apart from the moral issues involved, although benefit might accrue in individual cases, yet this would be nullified by the resultant increase in the number of cases exposed to infection. The Committee
therefore recommended
:-
451
an opinion, to be acquired only by a large and long experience. We are assured that medical officers who are possessed by the desire to do the best for their patients and to acquire knowledge for themselves would welcome an expert opinion. Might not the Ministry of Health select a certain number of experts from different parts of the country who would be willing when called upon to visit clinics on the request of the medical officer in charge ? Such experts would naturally work under the ægis of the advisor or advisors to the Ministry who have been, or may be, appointed. Since these consultants would only visit a clinic on the invitation of its medical officer, any objection to such a scheme on the score of interference or compulsion would be
-
"
That in connexion with its scheme for the diagnosis and treatment of venereal diseases the Council is not satisfied that the public provision of early preventive tteatment as suggested by the National Council for Combating Venereal Disease is desirable, and that tho National Council be informed accordingly."
nullified.
Systematic Care im the Sexual Diseases. We would ask our readers to consider what the result In an article with this title 1 Dr. James Bayard Clark, will be if this policy of passivity be persevered in. a practical account of the organisation, 1. If we regard the question in its bearings upon public U.S.M.C., gives and treatment routine at the Genito-Urinary equipment, health we shall find that a far larger number of patients Clinique at Camp Logan. Medical officers in charge of would ultimately require treatment for these diseases at a venereal treatment centres and those about to assume stage when it will be much harder and take more time to effect such command should study this graphic description with a care, whilst in some instances it will be impossible for care. Hospitals, municipal boards, and other bodies conthem to recover. Many sufferers before they recognise structively inclined might gain by assimilating the hints themselves as such will have communicated the infection to contained therein before to build. The descripof will be visitors to the others. Some these large towns, tion of the department beginning devoted to early or prophylactic who on returning to their country homes will find it difficult treatment possesses a particular topical interest in view of to secure adequate treatment for themselves or their conjugal the present tendency to initiate such early treatment victims. Whilst we are endeavouring to secure treatment for centres in the interests of civilian this
I
venereally-infected pregnant women and attempting to treat health. infants suffering from congenital syphilis and gonorrhoeal ophthalmia, we shall be neglecting the obvious course of trying to eliminate the factors responsible for the production of such lamentable results-in other words,
we
shall be pro-
a constantly increasing and preventable stream of maternal and infantile infection. 2. The community will achieve economy if those responsible for its welfare will adopt early preventive treatment. If they do not institute such centres then vastly increased sums will eventually be expended upon institutions at which an increasingly large number of patients suffering from the fully developed disorders will have to be treated. Further, great sums will be called for to maintain the army of parasyphilitic patients in asylums, infirmaries, More medical men will be required for the efficient &c. working of curative clinics as apart from preventive ones ; this will entail an augmented salary list and deflection of medical energy from other spheres. The loss to the nation in productive working power through patients incapacitated will be as immense as it will be unnecessary. Doubtless the National Council for Combating Venereal Diseases will not allow the position to remain as it is, and we ask our readers to augment their efforts.
viding wilfully
Hostels for Gonorrhaeal Patients. Medical officers in charge of venereal clinics are now faced with a variety of problems. A very difficult one is represented by the question as to what to do with patients suffering from gonococcal epididymitis who are unable to carry out the required treatment. Take the case of a man living in a single room, without attendance, unable to obtain a supply of hot water, and so on ; he is terribly handicapped, both as regards relief from suffering and ultimate recovery. His treatment entails more work and a greater demand on the resources of the venereal clinics. There is also in these cases a prolongation of the period of infectivity and a greater prospect of sterility ensuing. The general hospitals to which clinics are attached can hardly be expected to give up beds for this purpose ; but what objection can be advanced to the institution of hostels to which clinics can send those cases which cannot be treated adequately in their own homes ? The dictates of humanity, of national health, and of economy (financial and temporal) demand such a step, which we commend to the Ministry of Health. Once the practical necessity is admitted, the question of sites, staff, and salaries is capable of ready solution.
Travelling Consultants for Venereal Clinics. Owing to the rapidity with which venereal clinics are now being formed, it follows of necessity that many of the medical officers in charge of them are practitioners who have as yet had but small opportunity of gaining experience in such work. Cases will be brought before them which
" throughout
country
_______________
TUBERCULOSIS.
Treatmentfor Discharged -Residential Report lnter- Departmental of the
Sailors and Soldiers:: Committee.
THE Committee appointed last April by the Minister of Health and the Minister of Pensions"to consider and report upon the immediate practical steps which should be taken for the provision of residential treatment for discharged soldiers and sailors suffering from tuberculosis and for their reintroduction into employment, especially on the land," has issued its report (Cmd. 317, price 6d.). It is calculated that about 35,000 ex-Service men are suffering from tuberculosis traceable to, or aggravated by, the conditions of service. Of these, about 22,000 have received, or are receiving, residential treatment. Though it is conceded that the priority of treatment hitherto afforded the ex-Service man should continue, it is pointed out that the problem of the tuberculous ex-Service man is only one aspect of a national The present accommodation for institutional scourge. treatment is inadequate, for the number of beds for tuberculosis in the United Kingdom amounts only to 19,500, while only 10,000 to 11,000 of these are available for adult men. The report recommends an immediate and considerable increase of accommodation, as well as the most effective use of existing means of treatment. Generally speaking, Army hutments are unsuited for the treatment of tuberculosis, though the best of them, if used in their present position, may prove, at any rate, of temporary use. It is suggested that local authorities ought to secure these huts, without charge, from the Government. Of the many schemes submitted to it the Committee find the colony system the best. This would provide (1) sanatorium treatment, (2) training, (3) permanent village settlement with employment under medical supervision, the three sections being intimately correlated in the same area. It is suggested that the Government should at once make provision in the Estimates for £1,000,000 for the finance of village settlements, primarily for ex-Service men. These settlements might be provided by local authorities or voluntary bodies. In the former case the capital sum should be provided by the Government. After, say, five years, the local authorities might contribute to the cost by paying not less than one-fifth of the capital expenditure. The Committee insist on the superiority of sanatorium over home treatment for advanced cases, and urge local authorities and large employers of labour to provide special facilities for employment of those ex-Service men for whom the village settlement is not a satisfactory solution of their difficulties. 1
Journal of the American Medical Association,
April 26th, 1919.
NOTES FROM INDIA.-CONTROL OF VENEREAL DISEASES.
NOTES FROM INDIA. (FROM A REGULAR CORRESPONDENT.) - B’M<<6 Pastezcr Institute. AT the Burma Pasteur Institute during 1918-19 595 persons sought advice as compared with 426 in the previous year. The number of persons bitten by animals of proved taint who submitted to the full course of treatment fell from 183 in the previous year to 105 in the year under review. There were no deaths during the year from hydrophobia amongst those who submitted to treatment, whilst at least four deaths from this cause are reported to have occurred amongst 34 individuals who declined to undergo treatment.
Influenza Reorudescenoe. The following communique has been issued by the Government of India :Outbreaks of influenza are reported from Bombay, Calcutta., Rangoon, and Madras. These outbreaks do not (save in the case of Bombay) appear to have attained serious dimensions. Nevertheless, they coincide in time with the
effect from Dec. lst, 1918.1 This action of Government will help to allay the apprehension created by the grave state of affairs to which we have repeatedly directed attention, and it will also no doubt afford some encouragement to overworked officers of the I.M.S. who are almost at breaking point. There is no disguising the fact that the present position is well nigh desperate. More than 60 per cent. of the LM.S. civil officers are still in military employ, and military employments in India are increasing, not diminishing. India itself has been ransacked for doctors to make good the deficiency and the only hope now lies in making the terms of service so attractive that the necessary number of men will be forthcoming from the medical schools at home. We are glad to learn that the Government of India recognise that the matter is one of extreme urgency and are apparently determined to put it right. But it will not be so easy as it would have been before the war to obtain recruits by improving the conditions of the Service. There probably never was a time, indeed, when the opportunities open to medical men at home were so favourable as they are at present. This is an additional reason why there should not be a moment’s unnecessary delay in taking the definite action which the gravity of the situation demands.
War GratMity of the Indian Army. the British scale, the Government of India preliminary outbreaks of last year, and though there is announces that it has been decided to issue to regular officers no reason to an same of the I present apprehend epidemic the Indian Army, Indian Medical Service, and of the proportions the measure of immunity conferred on any I in individual by a previous attack is uncertain. Accordingly I, British garrison in India, and to departmental officers with the following steps have, among others, been taken as a honorary rank of the Indian Unattached List a gratuity for war service on the same conditions generally of those preliminary precaution. The Government of India have suggested to Maritime announced for officers of the British Army in Army Orders IV., Governments the taking of power to notify by rule under dated June 7th, 1919. The gratuity will be payable in the Indian Ports Act ship-borne cases of pneumonia, and the case of officers still on the active list on discretionary power similarly to deal with ship-borne cases 1919, or the termination of war as defined August 4th, by statutory of violent influenza. They have requested early intimation of all outbreaks in order that timely warning may be given authority, whichever is earlier. It is not payable to any Officers who officer commissioned after February, 1919. to the authorities in neighbouring areas and to the public. Stocks of anti-influenza vaccine are being made ready for have retired and the legal representatives of officers who early transfer to centres of infection. Surgeons and adminis- have died or been killed in the war should apply for a form trative medical officers are being invited to indent for of claim to the Secretary, Military Department, India Office, supplies to be ready on the spot in case of emergency. 1. S.W. London, A specialist has been deputed to Bombay to deal with the New Medical Scholarship. situation. Lieutenant-Colonel -W. D. Smith, commandant of the The Sanitary Commissioner with the Government of India has distributed widely a leaflet dealing with influenza and Madras Guards, has presented a scholarship valued at the course that should be taken in case of an outbreak. This Rs.1200 to the Madras Medical College for students in has been communicated to the press. He has specially recomand drugs. chemistry mended the use of an aniline nasal douche as an effective Calcutta f’nh’ersity G’orramissioa prophylactic. Though there is no immediate cause for alarm, it has been A summary of the report of the Commission has been thought advisable to inform the public of these new outbreaks published. It concludes as follows :in order that the necessary precautions may be taken and, Wedesire to make it clear that certain reforms in the should the disease show signs of further extension, other University of Calcutta ought not to be postponed whatever communiques will from time to time be issued. scheme be adopted-namely, the provision of further resiExtra medical precautions have been taken at Howrah dential accommodation, the provision of a teachers’ training station to meet returning pilgrims from Puri. It has been department, the provision of additional accommodation for ascertained that influenza is raging in epidemic form at teaching, and the provision of measures for supervising and Puri. At Howrah doctors treated 40 cases of influenza and improving the health of the students.. August 10th. 1 case of cholera.
at
Issuable
on
___________________
infant Welfare Exhibition at Delhi. maternity and infant welfare exhibition will be held in Delhi in February, 1920. It will be reserved for women on certain days, but will be open to men at other times. The proper care of mothers and babies will be shown by means of model exhibits, leaflets, lectures, pictures, magic-lautern The exhibition will be arranged in the following slides, &c. sections : pre-maternity, maternity, infant welfare, childhood, domestic hygiene, and sanitation, first aid and home nursing. A baby show will also be held. The whole will be under the patronage of Lady Chelmsford. It is hoped A
CONTROL OF VENEREAL DISEASES. Early Preventi1.’e Treatment and the N. O. C. v.n. A RECENT deputation from the National Council for Combating Venereal Diseases, led by Sir Malcolm Morris, was received by the Public Health Committee of the London County Council. Its object was to urge the County Council to make provision, through its scheme for the diagnosis and treatment of venereal diseases in London, for early preventive treatment-that is to say, "treatment at an approved centre within a short time after exposure to possible infection." The question also arose of treatment before exposure, and of the alleged objections to such treatment on the side of public morals. It was stated by the deputation that for early treatment to be effectual in the prevention of syphilis, it must be initiated within six hours after exposure to risk. It therefore follows that it would be necessary to institute a very large number of early treatment centres, accessible at all hours of the night and day. The Public Health Committee stated that with one exception the committees of all the London hospitals at which venereal clinics were in operation had definitely expressed the opinion that it would
that this exhibition may be the forerunner of many others both in Delhi and in other cities of India, and that it may lead to a great improvement in the condition of childbirth and the welfare of young children. Shortage of -11-redical Officers. A leading Indian journal says :We understand that the Government of India are drawing the attention of the Secretary of State to the extremely serious shortage of regular officers of the Indian Medical Service and urging recruitment of a large number of European officers for enrolment permanently. The Government of India have also proposed that certain measures recommended by the Medical Services Committee as likely to increase the attractions of the I.M.S. should be announced We further understand that the in England at once. 1 The new rates of pay for the military and civilian sides of the Indian increased rates of pay for the I.M.S. in civil employment will Medical Service were given in the Students’ Number of THE LANCET, be announced very shortly, and that these rates will takeAugust 30th, 1919, p. 398.
TUBERCULOSIS. call for
be impossible for them to introduce early preventive treatment on these lines. The National Council has made inquiry of medical officers of health of certain provincial towns, but apparently no steps have been taken to provide opportunities for such treatment. The Public Health Committee came to the considered conclusion that quite apart from the moral issues involved, although benefit might accrue in individual cases, yet this would be nullified by the resultant increase in the number of cases exposed to infection. The Committee
therefore recommended
:-
451
an opinion, to be acquired only by a large and long experience. We are assured that medical officers who are possessed by the desire to do the best for their patients and to acquire knowledge for themselves would welcome an expert opinion. Might not the Ministry of Health select a certain number of experts from different parts of the country who would be willing when called upon to visit clinics on the request of the medical officer in charge ? Such experts would naturally work under the ægis of the advisor or advisors to the Ministry who have been, or may be, appointed. Since these consultants would only visit a clinic on the invitation of its medical officer, any objection to such a scheme on the score of interference or compulsion would be
-
"
That in connexion with its scheme for the diagnosis and treatment of venereal diseases the Council is not satisfied that the public provision of early preventive tteatment as suggested by the National Council for Combating Venereal Disease is desirable, and that tho National Council be informed accordingly."
nullified.
Systematic Care im the Sexual Diseases. We would ask our readers to consider what the result In an article with this title 1 Dr. James Bayard Clark, will be if this policy of passivity be persevered in. a practical account of the organisation, 1. If we regard the question in its bearings upon public U.S.M.C., gives and treatment routine at the Genito-Urinary equipment, health we shall find that a far larger number of patients Clinique at Camp Logan. Medical officers in charge of would ultimately require treatment for these diseases at a venereal treatment centres and those about to assume stage when it will be much harder and take more time to effect such command should study this graphic description with a care, whilst in some instances it will be impossible for care. Hospitals, municipal boards, and other bodies conthem to recover. Many sufferers before they recognise structively inclined might gain by assimilating the hints themselves as such will have communicated the infection to contained therein before to build. The descripof will be visitors to the others. Some these large towns, tion of the department beginning devoted to early or prophylactic who on returning to their country homes will find it difficult treatment possesses a particular topical interest in view of to secure adequate treatment for themselves or their conjugal the present tendency to initiate such early treatment victims. Whilst we are endeavouring to secure treatment for centres in the interests of civilian this
I
venereally-infected pregnant women and attempting to treat health. infants suffering from congenital syphilis and gonorrhoeal ophthalmia, we shall be neglecting the obvious course of trying to eliminate the factors responsible for the production of such lamentable results-in other words,
we
shall be pro-
a constantly increasing and preventable stream of maternal and infantile infection. 2. The community will achieve economy if those responsible for its welfare will adopt early preventive treatment. If they do not institute such centres then vastly increased sums will eventually be expended upon institutions at which an increasingly large number of patients suffering from the fully developed disorders will have to be treated. Further, great sums will be called for to maintain the army of parasyphilitic patients in asylums, infirmaries, More medical men will be required for the efficient &c. working of curative clinics as apart from preventive ones ; this will entail an augmented salary list and deflection of medical energy from other spheres. The loss to the nation in productive working power through patients incapacitated will be as immense as it will be unnecessary. Doubtless the National Council for Combating Venereal Diseases will not allow the position to remain as it is, and we ask our readers to augment their efforts.
viding wilfully
Hostels for Gonorrhaeal Patients. Medical officers in charge of venereal clinics are now faced with a variety of problems. A very difficult one is represented by the question as to what to do with patients suffering from gonococcal epididymitis who are unable to carry out the required treatment. Take the case of a man living in a single room, without attendance, unable to obtain a supply of hot water, and so on ; he is terribly handicapped, both as regards relief from suffering and ultimate recovery. His treatment entails more work and a greater demand on the resources of the venereal clinics. There is also in these cases a prolongation of the period of infectivity and a greater prospect of sterility ensuing. The general hospitals to which clinics are attached can hardly be expected to give up beds for this purpose ; but what objection can be advanced to the institution of hostels to which clinics can send those cases which cannot be treated adequately in their own homes ? The dictates of humanity, of national health, and of economy (financial and temporal) demand such a step, which we commend to the Ministry of Health. Once the practical necessity is admitted, the question of sites, staff, and salaries is capable of ready solution.
Travelling Consultants for Venereal Clinics. Owing to the rapidity with which venereal clinics are now being formed, it follows of necessity that many of the medical officers in charge of them are practitioners who have as yet had but small opportunity of gaining experience in such work. Cases will be brought before them which
" throughout
country
_______________
TUBERCULOSIS.
Treatmentfor Discharged -Residential Report lnter- Departmental of the
Sailors and Soldiers:: Committee.
THE Committee appointed last April by the Minister of Health and the Minister of Pensions"to consider and report upon the immediate practical steps which should be taken for the provision of residential treatment for discharged soldiers and sailors suffering from tuberculosis and for their reintroduction into employment, especially on the land," has issued its report (Cmd. 317, price 6d.). It is calculated that about 35,000 ex-Service men are suffering from tuberculosis traceable to, or aggravated by, the conditions of service. Of these, about 22,000 have received, or are receiving, residential treatment. Though it is conceded that the priority of treatment hitherto afforded the ex-Service man should continue, it is pointed out that the problem of the tuberculous ex-Service man is only one aspect of a national The present accommodation for institutional scourge. treatment is inadequate, for the number of beds for tuberculosis in the United Kingdom amounts only to 19,500, while only 10,000 to 11,000 of these are available for adult men. The report recommends an immediate and considerable increase of accommodation, as well as the most effective use of existing means of treatment. Generally speaking, Army hutments are unsuited for the treatment of tuberculosis, though the best of them, if used in their present position, may prove, at any rate, of temporary use. It is suggested that local authorities ought to secure these huts, without charge, from the Government. Of the many schemes submitted to it the Committee find the colony system the best. This would provide (1) sanatorium treatment, (2) training, (3) permanent village settlement with employment under medical supervision, the three sections being intimately correlated in the same area. It is suggested that the Government should at once make provision in the Estimates for £1,000,000 for the finance of village settlements, primarily for ex-Service men. These settlements might be provided by local authorities or voluntary bodies. In the former case the capital sum should be provided by the Government. After, say, five years, the local authorities might contribute to the cost by paying not less than one-fifth of the capital expenditure. The Committee insist on the superiority of sanatorium over home treatment for advanced cases, and urge local authorities and large employers of labour to provide special facilities for employment of those ex-Service men for whom the village settlement is not a satisfactory solution of their difficulties. 1
Journal of the American Medical Association,
April 26th, 1919.