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14
due to the disease affecting the brain, 2 to tuberculosis
of the intestines and 1 to general tuberculosis. Two
cases died outside the district, 1 in the Union Infirmary
and. 1 in hospital. Ten cases were notified under the
New Public Health (Tuberculosis) Regulations. In all
of these the Medical Officer of Health visited the house,
verbal instructions were given as to what precautions
were called for to prevent spread of infection, and the
other members of the family interviewed. Excellent
printed instructions on cards handy for hanging on the
wall, as to the nature of consumption and the personal
and general precautions to be taken to guard against its
spread are supplied to each case and also disinfectants
for cleaning rooms and use in spitting vessels. The
cases are kept under observation. Should death ensue
or the patients change their abode, the infected premises
are cleansed and disinfected before being occupied again.
In this connection J would strongly advise the Council
to make arrangements for the free bacteriological examination
of sputem in suspected cases where the patients
are poor and also for the bacteriological examination of
discharges, etc., in cases of diphtheria and other infectious
cases where this is necessary in poor cases. By becoming
subscribers to one or other of the associations for this
purpose we could get this done at much reduced fees.
It would be prudent to keep in hand a small supply of
anti-toxin available for urgent cases.
In dealing with these cases under the Act, much
valuable time is lost through the delay which usually
occurs before they can be got into special hospitals or
Sanatoria for treatment. There is no doubt that each
County should have its own Sanatorium for the treatment
of these cases and that these could be made selfsupporting
to a large extent when once started and
equipped. These institutions are as necessary in their
way as Isolation Hospitals for treatment of scarlet fever,
&c. For the advanced cases, when cure is hopeless,
there are the Union Infirmaries, and these are the most
dangerous and infectious to the community because the
expectoration is frequent and copious. There is a scheme
in hand for the erection of a Sanatorium for Middlesex,
which, when completed, will provide for roo patients.
Wisely, it is intended to spend as little as possible on
the building itself, since it cannot but be a waste of
money to expend a large sum in excluding the air which
is an essential part of the treatment. It is believed
that the total cost, with the exception of the land,
which has been provisionally promised, need not