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Residential treatment for discharged tuberculous soldiers
November, 1919]
TUBERCLE
77
CRITICAL REVIEWS. RESIDENTIAL TREATMENT FOR DISCHAHGED TUBERCULOUS SOLDIERS. WE have already referred to the report' recently issued by the Interdepartmental Commitee appointed to consider " t he immediate practical s teps which should be taken for the provision of residential treatment for discharged soldiers and Bailors Buffering from pulmonary tuberculosis and for their reintroduction into employment, especially on the land." The report, a summary of which appears in our news columns, refers to the experience of local authorities who are finding that the tentative standards of the Astor Report, viz., one sanatorium and one hospital bed for every 5,000 population inadequate. In Glasgow, for instance, the accom modation is assessed at two and a ha.lf times, and the Middle Ward of Lanarkshire six times greater than the Astor standard. The failure of local bodies in many cases to attain even this deficient standard, the check imposed on further construction during the war, and the loan of many existing institutions to the War Office, are all given as factors in a problem of extreme difficulty. This Committee do not recommend that army huts should be used permanently as sanatorium wards, but consider that they should be used as a temporary measure where there is a serious deficiency. and until buildings, the plans of which are already in many instances prepared, can be completed.
the sanatorium, but that as treatment progresses, training in suitable occupations should commence, and it is recommended that centres should be attached to each sanatorium. Training colonies are to be regarded as extensions of san atoriums , work being prescribed as part of t he treatment . From a review of the existing training colonies. the Committee concludes that they are in g~neral intended for a limited period of BIX to. tW~lve months; during which the colonist IS under medical supervision and s~bsequ~nt to which he returns to ordmary life or passes into a more permanent settlement. The Committee emphasise the importance of developmg SUItable occupational training and regard agricultural work as not generally desirahls, The training centre should glV~ encouragement to the sanatorium patient by marking a stage in his progress to recovery. In considering the third stage, the Permanent Village Settlement the Committee have clearly been much impressed and influenced by the outstanding example at Papworth, where after six months' training the patient is offered permanent employment with a house in the village settlement. Employment is provided .. at the standard rate of wages in the district." It comprises carpentry, including furniture making, and such trades as boot making and tailoring, carried on in suitable workshops and under healthy conditions. There is also in addition, dairy work, poultry and farm work, but this is a secondary consideration. The Committee note that Training Colonies. there are no advanced eases in the village settlement, so that danger of its Having emphasised the urgent need being regarded as a leper colony does for immediate increase in residential accommodation the Committee turn not exist. The Committee conclude to Training Colonies and Permanent that the village settlement if developed Village Settlements. It is pointed out all over the country will be of material that treatment is the main function of help in dealing with the ex-service case and his resettlement in life. Recommendation is made that ten settleI Report of the Interdepartmental Committee (Residential Treatment ofDischarged ments of 250 men each together with Soldiers and Sailors). the 3,000 already in existence would
78
TUBERCLE
[November, 1919
The Importance of After-care. meet the need. As regards pensions, full treatment allowances should be The settlement can only deal with a. paid while in sanatorium or training very small proportion of the tuberculou$ colony, and full pension for at least a population ; seeing that it deals ~ith year after this, whether the man ente~8 small numbers for their wholehves. a village settlement or returns to hIS and with the strained finance of thes~ former life. After the year he should days, and the unfinished condition of be resurveyed and pension reassessed, existing schemes, it would appear but never at less than 50 per cent. sounder to have devoted energy and money to the development of dorma.nt schemes before branching into new 'and Permanent Village Settlements . relatively untried ventures. The most pressing need is the enlargemorrb of One point of practical importance after-care activities, the development arises from the undue importance which of conferences with employers of labour, the Interdepartmental Committee give to improve the hours and. conditions to the permanent settlements for patients of existing labour, and possibly to proincapable of facing unaided the stress vide suitable local workshops for the of industrial competition. While being tuberculous when ordinary channels concerned primarily with the ex' service are not forthcoming ; financial help men, they point out these cannot be when wages are not sufficient; stimuconsidered apart from the rest of the lation of house-building and housepopulation. They must therefore con- planning by the growth of local template a network of settlements propaganda; the enlagement of small throughout the country. Both the homes by the provision of shelters; report to the Local Government Board improvement in domiciliary treatment; hy Dr. Chapman' and the present report development in the quality and fremake it evident that the present marked quency of home visiting by tnore predilection for settlements is largely capable home visitors; and instl'Uc' due to dissatisfaction with the result of tion in the preparation and cooking of past methods, which as yet,have scarcely food. We are of opinion that these reached the fringe of after-care work. measures when fully developed will go The training centres in conjunction much the farthest to solve the problem with sanatoriums will probably be and show a much better return for the welcomed by all, but there are likely expenditure. to be more diverse views on the settlements which while being useful addiMORTALITY AFTER tions, must have very definite limitaSANATORIUM TREATMENT,! tions. There is a. tendency a.t tho moment to magnify these into a. panacea REALISING that an analysis of the for all tuberculous ills and such an results obtained by sanatorium treatrnent attitude is a danger, not only in is very important in the preparation of encouraging expenditure without fore- new schemes for dealing with tubercu_ sight but in detracting from the more losis, the Medical Research Committee humdrum measures which are the basis gave an annual grant in 1914 to aid of the present approved-an~ not yet the investigation of the after-histories disproved-methods, and WhI?h need of patients discharged from the King increasing rather than decreastng con- Edward VII Sanatorium at Midhurst. centration and pertinacity if their full The Sanatorium was opened in -19 0 6, value is to be obtained. and in the following eight years 1,707 I Pulmonary Tuberculosis: Mortality after I "Memorandum on the Share of Sa.natorium Treatment. Medica.l Research •Colonies' in the T:teatment of Tubercu- Committee, Special Report Series No, 33. losis," by J. E. Chapman. 1918. 2s. II.~f. Published by His Majesty's Stationery Stationery Office. Office. 19H),
TUBERCLE
77
CRITICAL REVIEWS. RESIDENTIAL TREATMENT FOR DISCHAHGED TUBERCULOUS SOLDIERS. WE have already referred to the report' recently issued by the Interdepartmental Commitee appointed to consider " t he immediate practical s teps which should be taken for the provision of residential treatment for discharged soldiers and Bailors Buffering from pulmonary tuberculosis and for their reintroduction into employment, especially on the land." The report, a summary of which appears in our news columns, refers to the experience of local authorities who are finding that the tentative standards of the Astor Report, viz., one sanatorium and one hospital bed for every 5,000 population inadequate. In Glasgow, for instance, the accom modation is assessed at two and a ha.lf times, and the Middle Ward of Lanarkshire six times greater than the Astor standard. The failure of local bodies in many cases to attain even this deficient standard, the check imposed on further construction during the war, and the loan of many existing institutions to the War Office, are all given as factors in a problem of extreme difficulty. This Committee do not recommend that army huts should be used permanently as sanatorium wards, but consider that they should be used as a temporary measure where there is a serious deficiency. and until buildings, the plans of which are already in many instances prepared, can be completed.
the sanatorium, but that as treatment progresses, training in suitable occupations should commence, and it is recommended that centres should be attached to each sanatorium. Training colonies are to be regarded as extensions of san atoriums , work being prescribed as part of t he treatment . From a review of the existing training colonies. the Committee concludes that they are in g~neral intended for a limited period of BIX to. tW~lve months; during which the colonist IS under medical supervision and s~bsequ~nt to which he returns to ordmary life or passes into a more permanent settlement. The Committee emphasise the importance of developmg SUItable occupational training and regard agricultural work as not generally desirahls, The training centre should glV~ encouragement to the sanatorium patient by marking a stage in his progress to recovery. In considering the third stage, the Permanent Village Settlement the Committee have clearly been much impressed and influenced by the outstanding example at Papworth, where after six months' training the patient is offered permanent employment with a house in the village settlement. Employment is provided .. at the standard rate of wages in the district." It comprises carpentry, including furniture making, and such trades as boot making and tailoring, carried on in suitable workshops and under healthy conditions. There is also in addition, dairy work, poultry and farm work, but this is a secondary consideration. The Committee note that Training Colonies. there are no advanced eases in the village settlement, so that danger of its Having emphasised the urgent need being regarded as a leper colony does for immediate increase in residential accommodation the Committee turn not exist. The Committee conclude to Training Colonies and Permanent that the village settlement if developed Village Settlements. It is pointed out all over the country will be of material that treatment is the main function of help in dealing with the ex-service case and his resettlement in life. Recommendation is made that ten settleI Report of the Interdepartmental Committee (Residential Treatment ofDischarged ments of 250 men each together with Soldiers and Sailors). the 3,000 already in existence would
78
TUBERCLE
[November, 1919
The Importance of After-care. meet the need. As regards pensions, full treatment allowances should be The settlement can only deal with a. paid while in sanatorium or training very small proportion of the tuberculou$ colony, and full pension for at least a population ; seeing that it deals ~ith year after this, whether the man ente~8 small numbers for their wholehves. a village settlement or returns to hIS and with the strained finance of thes~ former life. After the year he should days, and the unfinished condition of be resurveyed and pension reassessed, existing schemes, it would appear but never at less than 50 per cent. sounder to have devoted energy and money to the development of dorma.nt schemes before branching into new 'and Permanent Village Settlements . relatively untried ventures. The most pressing need is the enlargemorrb of One point of practical importance after-care activities, the development arises from the undue importance which of conferences with employers of labour, the Interdepartmental Committee give to improve the hours and. conditions to the permanent settlements for patients of existing labour, and possibly to proincapable of facing unaided the stress vide suitable local workshops for the of industrial competition. While being tuberculous when ordinary channels concerned primarily with the ex' service are not forthcoming ; financial help men, they point out these cannot be when wages are not sufficient; stimuconsidered apart from the rest of the lation of house-building and housepopulation. They must therefore con- planning by the growth of local template a network of settlements propaganda; the enlagement of small throughout the country. Both the homes by the provision of shelters; report to the Local Government Board improvement in domiciliary treatment; hy Dr. Chapman' and the present report development in the quality and fremake it evident that the present marked quency of home visiting by tnore predilection for settlements is largely capable home visitors; and instl'Uc' due to dissatisfaction with the result of tion in the preparation and cooking of past methods, which as yet,have scarcely food. We are of opinion that these reached the fringe of after-care work. measures when fully developed will go The training centres in conjunction much the farthest to solve the problem with sanatoriums will probably be and show a much better return for the welcomed by all, but there are likely expenditure. to be more diverse views on the settlements which while being useful addiMORTALITY AFTER tions, must have very definite limitaSANATORIUM TREATMENT,! tions. There is a. tendency a.t tho moment to magnify these into a. panacea REALISING that an analysis of the for all tuberculous ills and such an results obtained by sanatorium treatrnent attitude is a danger, not only in is very important in the preparation of encouraging expenditure without fore- new schemes for dealing with tubercu_ sight but in detracting from the more losis, the Medical Research Committee humdrum measures which are the basis gave an annual grant in 1914 to aid of the present approved-an~ not yet the investigation of the after-histories disproved-methods, and WhI?h need of patients discharged from the King increasing rather than decreastng con- Edward VII Sanatorium at Midhurst. centration and pertinacity if their full The Sanatorium was opened in -19 0 6, value is to be obtained. and in the following eight years 1,707 I Pulmonary Tuberculosis: Mortality after I "Memorandum on the Share of Sa.natorium Treatment. Medica.l Research •Colonies' in the T:teatment of Tubercu- Committee, Special Report Series No, 33. losis," by J. E. Chapman. 1918. 2s. II.~f. Published by His Majesty's Stationery Stationery Office. Office. 19H),