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and my staff. A few patients still discharge themselves prematurely from
tuberculosis hospitals and even manage to get back to work, and if they
abandon the treatment by anti-tuberculous drugs, may loose their germs
on an unsuspecting world. As the tubercle bacillus lives for such a long
time in body tissues, even longer than these germs persist in filth and
dirt outside the body, the treatment has to be prolonged and may last one
or even two or more years after discharge from hospital A great potential
danger is the patient with partly treated tuberculosis, who, though he
attends the chest clinic regularly and acccepts prescriptions, fails to
take the drugs prescribed. Well protected with its wax envelope, the
tubercle bacillus rapidly becomes able to resist even strong anti-tuberculous
medicines if these are not taken in the full amounts prescribed.
Twenty patients whose names were on the Tuberculosis Register died
in 1963, all except one from diseases quite other than tuberculosis. The
pulmonary tuberculosis element had been treated. At one time the
diagnosis of tuberculosis meant that one would die of it sooner or later.
In general, work at the Deptford Chest Clinic has actually increased,
and there were over 700 more attendances. Coincident with this my
medical assistant had his sessions reduced from four to three weekly.
A large number of chest x-rays were done on patients sent to me by local
general medical practitioners, an increase of 350 on 1962. The total
number of these newly referred cases, including 344 new contacts of
tuberculosis, was 1,583. Of these new arrivals at the clinic, 127 new cases
of pulmonary tuberculosis were diagnosed during 1963. Well over half
of these cases (71) were of moderate severity. I have recently seen for
myself that newly diagnosed cases of pulmonary tuberculosis in Southern
and Central Africa are very much more advanced in severity. In Deptford
the number of advanced cases of pulmonary tuberculosis has
decreased over the last few years. Of the 127 new cases of pulmonary
tuberculosis, 25 were shown to be coughing up tubercle bacilli at the time
of diagnosis. Counting old and new patients together, no less than 46
Deptford persons were known to be coughing up tubercle germs during
1963, and some of the bacilli were found to be resistant to the tuberculosis
drugs.
I have noted down the names of 50 patients from Carrington House who
attended this clinic for the first time during 1963. Of these, no less than
31 were found to have pulmonary tuberculosis past or present, and
usually the disease was active. The great majority had already had some
severe chest disease as well, frequently chronic bronchitis. Most of
the names of these men are already unfamiliar to me, as most of them
have already moved to other areas, frequently without a trace, and some
in the middle of a course of anti-tuberculous treatment. It is this mobile
population of tuberculous cases in lodging houses that keeps tuberculosis
a potential menace in London and possibly elsewhere. Carrington
House evidently needs an intensive case finding drive at frequent intervals
and also, in my view, needs an organisation fairly close at hand to deal
quickly with any abnormalities found in the inmates. I understand that
almost 1,000 men sleep there every night, rarely the same thousand.
During the latter part of 1963 an investigation was started on the
smoking habits of school children and other young people in Deptford