[Report 1909] / Medical Officer of Health, Sheffield City.

  • Sheffield (England). City Council.
Date:
1909
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1909] / Medical Officer of Health, Sheffield City. Source: Wellcome Collection.

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    Kill. Even under present conditions, we may conclude that most “ Contacts,” if they become infected, succeed in grappling successfully with the infection, because the number of deaths annually remains stationary, or shows a slight decrease, while the population increases. In other words, each victim to consumption bequeaths on the average, a fatal legacy to one person only. Important as examination of the “ Contacts ” may be, it must be more important to deal with the actual “ infecting ” cases at the home, firstly by educating them “ how not to infect,” and for this purpose a short period of training at a hospital is far more efficacious than any amount of advice and domestic visiting, and, secondly, by removing them to hospitals for advanced cases when they have reached that stage of the disease which renders them dangerous occupants of a home with limited accommodation, no matter how careful they may be. Dr. Newsholme has produced evidence tending to show that the isolation in Workhouse Hospitals of advanced cases has been the most powerful factor in the decline of the consumption death-rate in recent years. I append a table giving the Sheffield statistics with regard to this matter. Delicate “ Contacts ” may be suitable for the Open-air School or for Convalescent Homes. I hope part of the grant allocated by the Sheffield Council for sending consumptives to sanatoria will shortly be utilised for sending delicate “ Contacts ” to Convalescent Homes. Undoubted consumptives found among the Con¬ tacts ” are, of course, treated as ordinary notified cases. Hospitals for Short Periods of Educational Treatment. Hospitals are provided by the Corporation of Sheffield for short periods of treatment for consumptives at any stage of the disease except the last. By the short period of treatment it is hoped to educate the patient how to live without infecting others ; to give the relatives a rest and a chance of increasing their resistance to the disease, and to enable the home to be disinfected ; and to select by the best possible method curable cases to be sent on for prolonged treatment at a sanatorium. I would here lay special emphasis on the valuable educational effect of “ visiting day.” Sanatorium Treatment. Sheffield has no sanatorium of its own, and £1,000 is put in the Estimates for sending patients to other sanatoria. At present, there being no invalidity insurance scheme, we could not fill a 40-bed sanatorium with suitable cases from Sheffield. It might be more satisfactory to have a sanatorium of our own, one advantage in having the sanatorium directly connected with the complete scheme being that the preventive side may not be lost sight of. Thus, in many sanatoria, when the patient leaves he has not been educated, and he knows no more than when admitted how to deal with his sputum. Hospitals for Advanced Cases. If, after the short period of treatment, the patient is obviously going down hill, and at an advanced stage of the disease, and he cannot have a bedroom to himself at home, and has no means, every effort is made to get him persuaded to go straight into one of the Union Hospitals, where there are separate wards for con¬ sumptives. The Union Hospitals, therefore, provide for the most dangerous of the advanced cases. Compulsory power of removal would be useful in a few cases, but it is not likely to be granted for removal to a hospital administered under the Poor Law. After Care. The cases which return from hospitals or sanatoria to their homes continue to be visited by the Nurses. If cured, their names are removed from the list. There is, of course, the difficulty of finding work. The Guild of Help does what it can. An After-care Committee cannot meet this difficulty until the great question of the better organization of the labour market as a whole has been completed. No Need for Additional Medical Institution in the Form of a Voluntary Tuberculosis Dispensary in Sheffield. As things have developed in Sheffield, a dispensary would be no advantage. The sub-department of the Medical Officer of Health becomes in fact the dispensary and the bureau of information with regard to consumptives, and can do everything that a dispensary can do. The addition of a dispensary would only cause overlapping and duplication of work by the necessity for cross-reporting and a double system of registers and records. At present all the information is in one office. The out-patient departments at both hospitals co-operate in the scheme. We do not wish it to be thought that consumption is a thing to be shelved on to a special dispensary, and with which other medical institutions have no concern. All hospital wards and out-patient departments, both medical and surgical, will have to treat consumptives from time to time for complications. District nurses will be asked to visit them, and the Guardians will have to provide for them and also for their relatives if the bread winner is in hospital. All these bodies must feel that the prevention of consumption is their business and become allies in the campaign. I can well imagine that special out-patient hours for consumptives, or suspected consumptives, may be thought, in some towns, preferable to establishing a new medical charitable institution. Such out-patient consultations could be restricted to the use of delicate “ Contacts,” or, of patients unable to pay for a consul¬ tation in the case of whom the Medical Attendant desires a second opinion. The great thing is that the scheme should be comprehensive. It is too much to expect that each town will work out its salvation in exactly the same way. One of the weak spots in the scheme is that the bread-winner of the family usually remains at work until the disease is past the curable stage. Although the Guardians co-operate by allowing out-door relief while the bread-winner is at a sanatorium this defect in the scheme can only be met adequately by invalidity insurance.