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The work of the tuberculous
August, HI3G]
THE WORK OF TUB TUBERCULOUS
493
In Amsterdam the work is strictly centralised so that everything that a patient may need can be obtained only through the dispensary. In spite of the isolated organisation of the dispensary, the efiicient co-operation with the general practitioners, as well as the various public authorities, results in practically all tuberculosis patients being notified. Of the total annual deaths from tuberculosis (all forms) no per cent. arc known in the dispensary, in pulmonary cases as many as U5 per cent. The admission of patients to hospitals and sanatoria is arranged in Amsterdam by the dispensary, and .after discharge they are kept under regular control there. The following up of patients after discharge and the social rehabilitation and after-care is undertaken by the dispensary and the visiting nurses. The sanatoria receive their reports on discharged patients through the dispensaries. Each removal of a patient to another district is reported to the dispensary in question. About half of the new cases are sent to the dispensary by the general practitioners, one-third are contacts sent by the visiting nurses. In these contacts we include not only the children who arc exposed to tuberculous infection in theil' homes, but also the grandchildren, nephews and nieces, and even the neighbours' children of cases of open pulmonary tuberculosis. The prophylaxis for children from tuberculous families consists chiefly . in separation in the home. \Vhenever possible the infectious patient is hospitalised, which can be done in 80 per cent. of the newly-registered open cases. Hemoval of the children for several years (illuvre Grancher) is hardly ever resorted to in ;Holland. Infants who will grow up in immediate contact with open cases and contacts which after the patient has been hospitalised prove to be still uninfected, arc vaccinated with B.C.G. The death-rate from pulmonary tuberc·ulosis in Amsterdam is 3'40 per 10,000; from all fonns of tuberculosis it is 4'34.
THE WORK OF THE TUBERCULOUS,l By Professor PEllNAND BEZANct0N. Secretary-General of thc Illtcnzatioll
I HAVE been requested to address this joint meeting of the Tuberculosis Association with the International After-Care Committee of the International Union against Tuberculosis, on "'1'he \Vork of the 'l'uberculous." 'rhere arc few questions of greater practical importance. This problem has not so far taken the outstanding place it should occupy in our different congresses, and we cannot congratulate and thank too much the eminent speakers who, at a time when conditions of normal work are so difficult, have had the courage and optimism to approach this momentous subject. 1 A paper read nt the Provincial l\Ieeting of the Tuberculosis Association hcld at Cnmbridge on April, 2, 3 and 4, 1936.
·j94
TUDERCLE
[August, 1936
It is impossible to give too much praise to our illustrious host, Sir Pendrill Varrier-Jones, not only for having approached the problem but for having solved it. The English experiments of Pap worth and Preston Hall are for all nations a splendid example which should be followed. They are the indispensable complement of the fruitfulanti-tuberculosis work of the dispensary, for which we are _ also indebted to Great Britain, since it was in Edinburgh in -1887 that Sir Robert Philip-to whom we address the token of our admiration and regard-created the first disp~nsary. and also introduced into the antituberculosis campaign a. truly social as well as a medical spirit. Nearly all countries, great or small, rich or poor, to-day possess dispensaries. A few privileged ones only have their" Papworth." '1'he dispensary in its elementary form is relatively simple and its cost is small. 'Vhilst the village settlement is a very complex undertaking, to re-adapt to work individuals who are physically and morally handicapped, to give them a sense of discipline, to restore them to family life and its responsibilities, to find or create for them economic markets, appears at first an almost impossible task. It was Sir Penddll Vanier-Jones' rare merit to have understood the advantages offered by modern working conditions. 'Vhilst elsewhere machinery was considered a source of unemployment and a rival to handicraft, he saw that it could make up for the worker'sdeficiencies: a tuberculous patient who works an excellent machine is in a better position than a healthy workman ·with defective machinery. Sir Pend rill has been able to supply his tuberculous patients with magnificent factories equipped with all modern improvements. '1'he following figure will show the results obtained: 1934, at the height of the world-wide economic crisis, the Papworth sales organisation found a market for more than £100,000 worth of goods. Such facts need no comment. It is the privilege of forcible ideas to be born under the sign of contradiction. I do not think I am betraying any secret by recalling that even in Great Britain the idea of Pap worth called forth passionate controversies. Elsewhere its adoption gave rise to very strong opposition. Time will tell us what the future holds for this noble and generous initiative. For the moment we can only bow before the realisation of a wonderful dream. The dispensary and- the village settlement, so different and at first sight so remote one from the other, have, however, one feature in comlllon : the aim of both is to safeguard the" home," a word so specifically English that it has no equivalent in any other language. '1'he dispensary tries to protect the home and when tuberculosis gains the day the village settlement tries to rebuild on a new basis that which has been destroyed. This profoundly human solicitude, this persevering effort, this unity of view and action, bear the authentic signature of Great Britain.
THE WORK OF TUB TUBERCULOUS
493
In Amsterdam the work is strictly centralised so that everything that a patient may need can be obtained only through the dispensary. In spite of the isolated organisation of the dispensary, the efiicient co-operation with the general practitioners, as well as the various public authorities, results in practically all tuberculosis patients being notified. Of the total annual deaths from tuberculosis (all forms) no per cent. arc known in the dispensary, in pulmonary cases as many as U5 per cent. The admission of patients to hospitals and sanatoria is arranged in Amsterdam by the dispensary, and .after discharge they are kept under regular control there. The following up of patients after discharge and the social rehabilitation and after-care is undertaken by the dispensary and the visiting nurses. The sanatoria receive their reports on discharged patients through the dispensaries. Each removal of a patient to another district is reported to the dispensary in question. About half of the new cases are sent to the dispensary by the general practitioners, one-third are contacts sent by the visiting nurses. In these contacts we include not only the children who arc exposed to tuberculous infection in theil' homes, but also the grandchildren, nephews and nieces, and even the neighbours' children of cases of open pulmonary tuberculosis. The prophylaxis for children from tuberculous families consists chiefly . in separation in the home. \Vhenever possible the infectious patient is hospitalised, which can be done in 80 per cent. of the newly-registered open cases. Hemoval of the children for several years (illuvre Grancher) is hardly ever resorted to in ;Holland. Infants who will grow up in immediate contact with open cases and contacts which after the patient has been hospitalised prove to be still uninfected, arc vaccinated with B.C.G. The death-rate from pulmonary tuberc·ulosis in Amsterdam is 3'40 per 10,000; from all fonns of tuberculosis it is 4'34.
THE WORK OF THE TUBERCULOUS,l By Professor PEllNAND BEZANct0N. Secretary-General of thc Illtcnzatioll
I HAVE been requested to address this joint meeting of the Tuberculosis Association with the International After-Care Committee of the International Union against Tuberculosis, on "'1'he \Vork of the 'l'uberculous." 'rhere arc few questions of greater practical importance. This problem has not so far taken the outstanding place it should occupy in our different congresses, and we cannot congratulate and thank too much the eminent speakers who, at a time when conditions of normal work are so difficult, have had the courage and optimism to approach this momentous subject. 1 A paper read nt the Provincial l\Ieeting of the Tuberculosis Association hcld at Cnmbridge on April, 2, 3 and 4, 1936.
·j94
TUDERCLE
[August, 1936
It is impossible to give too much praise to our illustrious host, Sir Pendrill Varrier-Jones, not only for having approached the problem but for having solved it. The English experiments of Pap worth and Preston Hall are for all nations a splendid example which should be followed. They are the indispensable complement of the fruitfulanti-tuberculosis work of the dispensary, for which we are _ also indebted to Great Britain, since it was in Edinburgh in -1887 that Sir Robert Philip-to whom we address the token of our admiration and regard-created the first disp~nsary. and also introduced into the antituberculosis campaign a. truly social as well as a medical spirit. Nearly all countries, great or small, rich or poor, to-day possess dispensaries. A few privileged ones only have their" Papworth." '1'he dispensary in its elementary form is relatively simple and its cost is small. 'Vhilst the village settlement is a very complex undertaking, to re-adapt to work individuals who are physically and morally handicapped, to give them a sense of discipline, to restore them to family life and its responsibilities, to find or create for them economic markets, appears at first an almost impossible task. It was Sir Penddll Vanier-Jones' rare merit to have understood the advantages offered by modern working conditions. 'Vhilst elsewhere machinery was considered a source of unemployment and a rival to handicraft, he saw that it could make up for the worker'sdeficiencies: a tuberculous patient who works an excellent machine is in a better position than a healthy workman ·with defective machinery. Sir Pend rill has been able to supply his tuberculous patients with magnificent factories equipped with all modern improvements. '1'he following figure will show the results obtained: 1934, at the height of the world-wide economic crisis, the Papworth sales organisation found a market for more than £100,000 worth of goods. Such facts need no comment. It is the privilege of forcible ideas to be born under the sign of contradiction. I do not think I am betraying any secret by recalling that even in Great Britain the idea of Pap worth called forth passionate controversies. Elsewhere its adoption gave rise to very strong opposition. Time will tell us what the future holds for this noble and generous initiative. For the moment we can only bow before the realisation of a wonderful dream. The dispensary and- the village settlement, so different and at first sight so remote one from the other, have, however, one feature in comlllon : the aim of both is to safeguard the" home," a word so specifically English that it has no equivalent in any other language. '1'he dispensary tries to protect the home and when tuberculosis gains the day the village settlement tries to rebuild on a new basis that which has been destroyed. This profoundly human solicitude, this persevering effort, this unity of view and action, bear the authentic signature of Great Britain.