54
the number of deaths. On the basis of this calculation,
o n e m i l l i o n p e o p l e m u s t b e t e m p o r a r i l y o r p e r m a n e n t l y i n v a l i d e d
by the disease, 20 per cent. or 200,000 of whom are
s u p p o s e d t o c o n s t a n t l y s c a t t e r t h e i n f e c t i o n , t h r o u g h s p u t u m o r o t h e r
body discharges, to healthy people around them".
7.
7. *It is generally estimated that there ought, in any country, to be
as many beds available for tuberculous patients as there are deaths from
tuberculosis during the year. At a rough estimate there are 500,000
deaths a year from tuberculosis, which means, on the above method of
calculating the necessary accommodation, that there should be that number
of beds, i.e., 500,000 available in India in hospitals or sanatoria for the
treatment of tuberculosis. The table at the end of this chapter shows
the number of beds available in India for tuberculosis patients together
with the number of clinics which have been established to deal with the
disease. In all India there are only 77 clinics and 39 sanatoria and the
total number of beds available is approximately 2,768.
8. It is obviously impossible with the limited financial resources avail-
-able to provide the institutional accommodation in India which the League
of Nations Report considered necessary. We must therefore concentrate,
as far as possible, on methods which will safeguard future generations
while providing as much aid as possible both by institutional and domiciliary
treatment to the infected patients. An unofficial committee of doctors
on behalf of the King George Thanksgiving (Anti-Tuberculosis) Fund con-
-sidered this problem in all its aspects and finally drew up the following
proposals for a campaign against tuberculosis:—
"(1) Tuberculosis Dispensary Clinic. —This institution occupies a front position in
the organisation for combating Tuberculosis in a given area and is the centre for
preventive work.
In urban areas Tuberculosis Dispensaries should be established having their own
staff under a Medical Officer, either full time or part-time. Except in cities suffi-
ciently large to warrant the establishment of a separate building fully equipped and
staffed, it is advisable to locate the Tuberculosis Dispensary within the boundaries of
a well established hospital, in order to utilise the facilities for X-ray diagnosis and
surgical work that should be obtainable there.
In rural areas, on the other hand, with scattered and less developed communities,
the organisation of separate Dispensaries devoted solely to tuberculosis work is im-
practicable and here tuberculosis clinic should be opened in existing dispensaries on
one or more fixed days each week.
Emergency beds, attached to a Tuberculosis Dispensary Clinic are useful for
patients requiring observation for a day or two or for minor surgical treatment, but
patients should not ordinarily be retained in such beds for more than a week.
(2) Domiciliary Treatm ent.—Owing to the small number of beds available for tuber-
culosis cases in general hospitals and special tuberculosis institutions, domiciliary treat-
ment must perforce be resorted to in a majority of cases for many years to come. In
home treatment and care of patients and their families, the Health Visitor and the
Care Committee play an important part. These are discussed below. The organisa-
tion of open air centre where patients can be kept by day may be helpful especially
when patients come from congested areas.
(3) Health Visitor .—Formerly known as the Tuberculosis Nurse this worker is
preferably a woman and a trained nurse. Owing however to the great shortage of
women nurses in India it will be necessary in many areas to employ others to
* General Principles governing the prevention of Tuberculosis—Quarterly Bulletin
of the Health Organization, League of Nations, Vol. I, No. 4, December 1932.