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WHITE PLAGUE WAR. Year's Work in Breconshire. A bulky volume just issued by the Welsh National Memorial Association contains the report of Dr. A. C. Johnson, tuberculosis physician for Breconshire and Radnorshire, on the work done in the two counties during the year ended March 31st. This report states Progress during the year has been fairly satisfactory; only during the last quarter has there been any considerable increase in the number of patients examined. The total cumber of new cases examined represents an I increase of 25 per cent. on last year's total, but the number found to be tuberculous has slightly diminished. About 42 per cent. of the cases examined showed signs of active disease. Of the re- mainder, some were suffering from other diseases, such as cancer, heart disease, and, in the case of children, enlarged tonsils and adenoids and whooping cough. Many others, especially women and children, presented signs of no definite disease, but were in a condition of chronic ill health, which could be attributed only to bad teeth, bad feeding and bad housing. The problem of bad teeth is very pressing both among tuberculous patients and others. Only one patient with a full set of sound teeth has been seen in the area in the last eighteen months. The diet in the rural districts consists too much of tea and bread and butter. In the industrial districts to the south of Brecon there is more variety, but tinned foods of low nutritive value are depended on far too much. In this respect, the lectures which are being given in all the schools should have good results. There has been little improvement in housing conditions. The majority of people are agreed that there ought to be better houses for the people-especially tuberculous patients-but no one is prepared to build them. Sanitary authorities are in many cases anxious to condemn the worst cottages, but are prevented from doing so by the fact that there are no others available. At the recent Local Government Board housing inquiry in Brecon, in seems to have been clearly proved that there was a great demand for modern four and five roomed houses by people who could pay a fair rent, but that there were not enough available. Patients themselves have often said, I know this is not a suitable house, but I cannot get another." The outbreak of war has put a stop to some housing schemes, and it seems that nothing further will be done for the present. APATHY OF PATIENTS. No new Visiting Stations have been opened during the year. It has been found sufficient to visit some of the districts once a fortnight, instead of once a week, owing to the small number of patients. It has frequently happened that a patient has attended once or twice, a diagnosis is made, and treatment recommended, and then the patient is not seen again. Visits are made by the nurse, and the patient often promises to come next time," but usually does not. Such patients often continue at work until they can no longer do so, and then they ask (when there is no hope of improvement) to go to a sanitorium. On the other hand, when the patients really make up their mind to try to get better, some very good results have been obtained. It is not only those patients in the earliest stages of the disease who make great improvement; many with a consider- able amount of disease, as estimated by physical examination, who are determined to make a fight for it, have shewn very great improvement and have ultimately returned to work via hospital and sanitorium. I am convinced that the mental factor is of the greatest importance in the treatment of tuberculosis. The chief event of the year has been the provision of beds for the area in the Pontsarn Hospital, which was taken over by the association on December 1, 1914. Already the good effects of having beds expressly for this area, and under the supervision of the tuberculosis physician, are being felt. The waiting period has been greatly reduced, and several patients with a doubtful prognosis have been admitted almost at once, as well as advanced cases, in which the surroundings are bad. Already many patients have sufficiently improved to be transferred to sanitorium. Few patients can be recommended for sana- torium treatment at once; it is almost always necessary to give a certain amount of hospital or institute treatment first, even if it is only to enable the patients to have dental treat- ment. The sanatorium may be regarded as the optimum form of treatment, and should be confined to those patients who have a good chance of permanent improvement. It is not fair to the patients themselves to send them to a sanatorium when they are not likely to do well. They soon get despondent when they find the others around them improving, while they remain stationary. This point is often not realised by the general public, and sometimes by members of health committees and even doctors. For example, public complaint was recently made because, among other things, a patient with a temper- ature of 103 degrees was sent to hospital and not to a sanatorium. Domiciliary treatment has been given by the general practitioners in a considerable number of cases. The combined form of treatment in which the patient attends a visiting station once a fortnight or once a month, and is seen by his own doctor in between, when necessary, has proved valuable in country districts. It is to be regretted that disinfection is not always done after the death or removal of a patient. The sanitary authorities are usually anxious to have this done, but in many dis- tricts there appear to be no really efficient means of disinfection at their disposal. In several cases, clothing of the deceased patient has been removed before disinfection has been carried out, thus conveying considerable risks of infection.





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