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taken can hardly be said to extend so far. Especially should it be noted that they do not include
any systematic effort such as would be effected by their medical examination, to ascertain whether
other members of the family were suffering from tuberculous disease. This, indeed, appears to be a
matter of first importance, for the early detection of the disease and the provision of appropriate
treatment of the patient seem at the present time the most promising of the measures which can be
adopted.
Generally it may be said that medical officers of health do not find themselves able to seeure
the necessary accommodation for patients needing removal to an institution whether in the hope of
the patient's recovery or merely of his receiving temporary relief. At the time of Dr. Wanklyn's report
one sanitary authority had arranged for beds in a sanatorium to be available for the use of the
inhabitants of their district. This authority (Woolwich) has provided seven beds at the Peppard
Sanatorium.
Especial mention should be made of a dispensary for the prevention of consumption which
has been instituted in Paddington. This dispensary is modelled on the lines of the Royal
Victoria Dispensary for Consumption which some twenty years ago was instituted in Edinburgh
by Dr. R. W. Philip. The special feature of this dispensary, which is supported by voluntary
contributions, is that the staff concern themselves not only with the treatment of the patient
at the dispensary but supervise him in his home. Thus members of the family of the sufferer
are brought into direct relation with the physician, are examined by him, and brought under
early treatment. The dispensary works in close co-operation with the Charity Organisation
Society and the Invalid Children's Aid Association from both of which material assistance
is given according to the wants of the family. Effort is made to preserve the relation of the
dispensary with the sanitary administration of the district by the appointment of the medical officer of
health, Dr. Dudfield, as chairman of the Committee of Management. "The physician who works in
association with a specially trained nurse is able," Dr. Dudfield writes, "to effect a remarkable
improvement in the home conditions, and thus to minimise the spread of the disease." The advantages
of this system are the opportunity it affords for the supervision of the home conditions of the
patient by the physician who is attending him, and the facilities it gives for the early detection of
pulmonary tuberculosis in other members of the family and for making available the aid of philanthropic
bodies when this is needed. Such institutions would, if continuous efficiency of administration were
ensured, overcome some of the difficulties which are now experienced in dealing with persons suffering
from pulmonary tuberculosis.
Other procedures of sanitary authorities which have been generally adopted are the giving of
facilities for the examination of sputum, the supply of sputum bottles and the offer of disinfection
after the death or removal of the patient.
Shirley F. Murphy,
Medical Officer of Health.
1814
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