Final report of the Departmental Committee on Tuberculosis.
- Great Britain. Treasury. Committee on Tuberculosis.
- Date:
- 1913
Licence: Public Domain Mark
Credit: Final report of the Departmental Committee on Tuberculosis. Source: Wellcome Collection.
203/226 page 185
![should be utilised for treating tuberculous children, I can see no grave objection to it, provided that the chil- dren’s pavilions are kept apart, that no great expense is incurred in their erection, that the climatic conditions are sound, that they are under skilled surgical super- vision, and that the treatment of the children is not made subsidiary to that of the adults. III. Such Places must be Conducted on Hospital Lines and not on those of Convalescent Homes and Houses of Refuge—These places and the method of treatment should be under the immediate supervision of a surgeon, who should have been specially trained to the work and have particular knowledge of the subject in all its branches. Such officers are also to be fully acquainted with the modern pathological technique and the methods of clinical research. They should be capable of carrying out details of scientific investigation at the wish and under the guidance of the Chief of the Central Clinical and Bacteriological Laboratory, which for purpose of convenience should be in the immediate neighbourhood of the central institute (see page 7). The surgeons must also be skilled radiographers. It follows from the nature of their duties that the whole of their time should be devoted to them; and the salary to secure the whole time of reliable officers should be about five or six hundred pounds per annum. There is, however, little or no doubt that we do not possess in this country more than a few men, and certainly a totally inadequate number of them, who are capable of performing these duties. It will there- fore be necessary to train such a body of men under surgical experts specially appointed for the purpose. These experts may be either members of the Advisory Committee (see page 9) or be appointed for training purposes by the advice of the expert members of that body. It is also suggested that the surgical officers of the local institutions should have opportunities from time to time of studying methods carried out abroad ; and, for this purpose leave with full pay should be granted. In considering this scheme it is presumed that the treatment of surgical tuberculosis in children will be dealt with either by the Insurance Committees of each county or by the county councils. IV. Admission to the Hospitals. — Admission to hospitals should be hedged in with as few restrictions as possible. The mere fact of the existence of the disease before the age of 15 years shall be the ground for admission; further, patients shall not be kept waiting for a vacancy. When a case is sent, the surgical officer shall decide whether it is curable or not and shall deal with it accordingly. If incurable, special provision shall be made for the case (see page 7). If curable, the consent of the parents to the stay of the child in hospital for at least one year shall be obtained, after they have had the advantages of treat- ment pointed out to them; and, at the beginning of a second year the permission of the parents shall be renewed, and so on as long as necessary. Tender age should be no bar to admission ; because, the younger the child is, the more responsive it is to the influences of climatic surroundings, plentiful food, fresh air, and local treatment of the disease. V. Duration of Stay.—The duration of stay in hospital of the patient shall be decided only by the progress he makes and the question of his curability, with the exception of that of attaining the age of 15 years. If the patient, at the age of 15, years is in the way of cure, special arrangements may be made for his further stay so as to complete it. VI. Following up Cases.—An essential feature in the ultimate success of climatic and conservative treatment is the following up of patients by officers appointed for the purpose, after the patients leave the hospital. The object of following up is to ascertain if the patients’ surroundings are suitable, and if there are signs of relapse; herein is one of the many values of thorough and complete registration of all cases. VII. Education of Children whilst under Observation. —The education of the children shall continue to be under the direction of the Board of Education or of the Education Committee of County Councils, and will probably follow the plan now in work at the Royal National Orthopedic Hospital in London. VIL. Teaching Trades to Tuberculous Cripples.— As the ultimate objects of the Scheme are to convert diseased into healthy individuals, and dependent, or partially dependent into independent self-sustaining men and women, who will become useful members of society, it is necessary that each should, if possible, be taught a trade. Special teachers and methods are required for those who, being crippled, cannot be restored to perfect physical conditions; and instruc- tion in particular trades must be provided, if they are to be enabled to earn a satisfactory livelihood. The State of Nebraska has recognised these facts, and, since 1905, 450 children have been treated for their diseases, educated and trained. Among the trades may be mentioned carpentry, leatherwork, trunk-making, basket-weaving, printing, photography, metal-work, sewing, and typewriting. IX. Special Provision for Incurable Cases.—Here we approach a difficult side of the subject. Some parents will, no doubt, welcome kind and considerate care for their afflicted children provided that they have free access to them, others may object. For the former class of children, a few hospitals for incurables should be provided ; for the latter, some of the most pressing indications may be met by arranging for visitors to look after their welfare, to see that their surroundings are as healthy as possible, that they have necessary comforts, and medical aid, and to ensure that they are not a source of transmission of infection to others. Number of Beds Required—From the experience gained here and in America, it is clear that, when hospitals for tuberculosis are generally provided, the number of cases suitable for admission will be found to be out of all proportion to that which could possibly have been anticipated. Assuming that there are 7,500,000 children under the age of 15 years in this country, provision should at first be made for one bed in 5,000. This means there should be 2,500 beds. I venture to think, however, that the number of children under the age of 15 years is nearer 10,000,000 than 7,500,000. If we,'however, accept 7,500,000 as the number of children under 15 years of age in this country, I believe the number of 2,500 beds will be found too small, and Iam inclined to think that 4,000 beds may be required when the Scheme is in full work. Since, however, under efficient treatment the number of children affected with tuberculosis in this country will decrease, this number of 4,000 beds will be lessened ultimately. Prime Cost of Beds —From the statistics given in the reports of various institutions in this country and America, we find that the highest average prime cost of hospitals is 1507. per bed, so that to provide for 2,500 beds 375,0001. may be required, or if 4,000 beds are in working order, the prime cost may be 600,0001. The average prime cost ought not to exceed 1001. per bed, and therefore these estimates may be reduced by one third. Cost of Maintenance.—It is found that the cost of maintenance of an invalid in such an _ institution averages 65]. to 751. per bed per annum, so that the average cost of maintenance of 2,500 beds will be 175,0001. a year, and of 4,000 beds 280,0007. 1 am, however, of opinion that with efficient management the cost of maintenance should not exceed 501. per bed per annum. RESEARCH. There are at least four problems of immediate urgency, they are :— I, The development of tuberculosis in cattle and other animals and the means whereby it can be eradicated. II. Methods of entrance of bovine bacilli into human beings, and of infection of human beings by the tubercle bacillus of man, and how prevention can be obtained. III. The values and uses of the many forms of tuberculins.](https://iiif.wellcomecollection.org/image/b32182041_0203.jp2/full/800%2C/0/default.jpg)
