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22
Pulmonary Tuberculosis.
During the year 1913, 249 persons were notified as suffering from
pulmonary tuberculosis, but only 160 of these were actually new cases
not previously notified. There were 63 notifications of other forms of
tuberculosis ; and with 6 exceptions these were all new cases, that had
not been previously notified, as prior to the 1st February notification was
restricted to pulmonary cases.
Forty-one specimens of sputum were sent during the year by medical
practitioners to the Lister Institute for free bacterioscopic diagnosis. Of
these 13, or 32 per cent., showed the presence of tubercle bacilli, and 28,
or 68 per cent., did not.
Of the notified cases of pulmonary tuberculosis on the register, 41
died during the course of the year. Ten of these cases were only notified
a few days (1 to 10) before the fatal termination of the illness. Twentysix
of the cases had been notified for periods ranging from 1 to 11 months
before death ; and 4 of the cases had been notified between 1 and 2 years.
One case had been on the register 4 years.
Of 83 new cases of pulmonary tuberculosis (mostly adults) entered in
the register for the year 1913, of which fairly full notes have been
obtained as the result of visits to, and enquiries made at the homes of the
patients by the Lady Sanitary Inspector, in 16 there was a history of
tuberculosis amongst near relatives, and circumstances pointed to direct
infection from the tuberculous relative. In 28 cases the tubercular
infection appears to have been preceded by an attack of bronchitis,
influenza, pneumonia, or neglected nasal and bronchial catarrhs. In
3 cases the illness was attributed to constant exposure to cold and wet.
Badly ventilated or dusty workrooms and offices are associated with
8 cases; phthisical fellow-workers with 3 cases; living in basement
rooms with 2 cases; previous injury to the chest with 3 cases; and one
case each is attributed to drink aud bad habits, habitual over-fatigue,
want of sufficient food, and nursing a phthisical patient.
Of these 83 cases, 45 were found on the date of the first visit by the
Lady Sanitary Inspector to be sleeping alone (with a bed to him or herself),
and 36 were sleeping in bed with some other person. In more than
half of the latter cases the patients were induced subsequently to make
arrangements to sleep alone. Four beds with the necessary bedding have
been provided for this purpose by the Chelsea Borough Council, and were
lent to necessitous cases during the year, with great advantage to the
sufferers. About three-quarters of the cases visited are found to be able
and willing to carry out sanitary precautions as regards disposal of sputa,
burning of infected rags, having windows open, and keeping the rooms
occupied clean and free from dust and dirt. About one-quarter of the
cases are somewhat unsatisfactory to deal with, owing to carelessness and
scepticism as to infection and the necessity for fresh air and cleanliness.
In nearly every case, however, some improvement is effected as the result
of the visits made.
In the period 13th July, 1912, to 31st December, 1913, during which
the Sanatorium provisions of the National Health Insurance Act, 1911,