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21
Contact work is improving again, and the figure of 4,019 shows a marked improvement
on the 2,842 of 1958 and 2,492 of 1957. Many more contacts and others are now
receiving B C G vaccination shortly after birth.
The general trend of the annual figures for 1959 is similar to those seen in
clinics all over the country and reflects the effect of the still rapidly falling
death rate on the total attendances and new notifications.
The effects of chemotherapy in prolonging the life of patients with disease and
eradicating sources of infection is only now becoming reflected in the falling
notification rate. This withdrawal of infection from the population is also affecting
the percentage of Mantoux positive reactors found in school-leavers which has fallen
from 33% in 1948 to 10% in 1959, thus leaving a larger pre-puberty population at risk
each year. Whilst full employment remains and living standards are good, this may be
satisfactory, but the remaining sputum positive individuals who are still known to
remain in the population present an ever present risk if these standards should fall
again to those of the hungry thirties. Whilst we should all rejoice that the captain
of the men of death has been laid low, no one in the epidemiological and preventive
medical service can afford to become complacent.
Some part of the increase in attendances is caused by the need for follow-up and
after-care of patients who previously in the pre-chemotherapeutic period would have
died within 5 years, but whose disease now becomes quiescent or arrested. These
patients require several years of chemotherapy and, after their tuberculosis has
subsided suffer considerably each winter from the resultant pulmonary fibrosis and
emphysema.
The age distribution of pulmonary disease has not altered appreciably in Fulham.
although the figures in each age group are too small to be significant -

AFTER CARE
During the year the social care work continued as usual and was concerned with
both tuberculous and non-tuberculous patients, about 1,100 interviews being given.
The operation of the Local Health Authority care and after-care service could be
seen for example in the grant of free extra nourishment to tuberculous patients (an
average of 63 at any onetime), in recuperative holidays free or at reduced charges (27),
in home diversional therapy (3 sessions a week) and referrals to the home help service.
Close co-operation was maintained with the National Assistance Board, especially
over extra nourishment allowances for those not eligible for the Local Health Authority
grants in kind and with many other statutory or voluntary social service agencies.
Of the latter, the Fulham Tuberculosis Care Committee, of which the Care Organiser is
secretary, helped 43 patients with fares, holidays, removal expenses, clothing etc.,
from its Samaritan Fund and made special gifts at Christmas time.