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Table I.
Whole
Borough.
Bermondsey Wards.
Rotherhithe
Wards.
St. Olave
Wards.
St.
Olave.
St.
Thomas.
1
2
3
4
5
6
1
3
St.
John.
2
13
14
17
14
5
9
7
-
2
-
3
104
20
Voluntary Notifications
12
4
22
10
235
45
23
27
12
9
25
44
2
Poor Law Notifications
339
58
37
44
32
23
53
24
10
5
30
19
4
Total
242
39
42
16
23
7
26
40
11
6
16
12
4
Re - Notifications (changes of
address, &c.)
38
22
31
12
17
6
5
196
29
2
2
18
Rooms Disinfected
14
In Table I. will be found the voluntary and poor law notification for the 52 weeks ended
April 2nd, 1910. This period was chosen as it gives a year's working of the poor law notification
after the scheme was well started, and from this it is evident that we only hear of a small number
of probable cases. This much may, however, be said, that we hear of the majority of the advanced
cases, for the poor law notifications consist of little else. In the case of the voluntary notifications
we often get cases in the early stages, and before they are incapable of working.
The procedure as regards prevention is somewhat different according to whether the
notification is voluntary or poor law. If the former, the case is visited directly by myself and the
necessary inquiries made and precautions recommended. Disinfection is advised but not always
accepted. We have, however, been more successful recently in getting this carried out, since the
people are beginning to understand its value. Secondary visits are, as a rule, not paid, since time
and other duties do not permit of it.
In the case of poor law notifications it has been found that as patients do not come under the
guardians as a rule till the last stage of the illness, when they are no longer capable of supporting
themselves or families, and see the parish doctor only as a preliminary to removal into the infirmary,
it saves time to get the sanitary inspector to visit the house and see if the patient has gone or intends
going into the infirmary. If the patient decides on the latter the names and ages of the contacts
are obtained and disinfection is arranged for. Of the 235 poor law cases notified during the period
to which the above table refers, 103 went into the infirmary either immediately or very shortly after
notification, and those who elected to be treated at home were visited and advised by me.
It is these visits which have impressed me greatly with the necessity of doing something more
to assist consumptives in their illness. For various reasons they do not care to go into the infirmary,
and those who enter it generally do so from sheer necessity. It is a great pity that this should be
so, since an infirmary to which advanced cases readily resorted would be a powerful weapon in
preventing the spread of the disease.
You visit a house and find the father of the family in advanced phthisis, possibly bed-ridden,
with one or two rooms at his disposal. He is sleeping in a room with other members of the family,
not earning any money, and therefore has insufficient food and clothes, and there is added to this
insufficient fresh air. With such a state of affairs, the advice of the Medical Officer of Health
frequently seems somewhat farcical both to himself and to the patient. All I can offer him is
a little disinfectant and a spit-pot.
Now in considering what further measures might be undertaken by the Council, it will assist
if one considers the different classes of cases to be dealt with. "Consumptives" may be roughlydivided
into three classes, according to the stage of the disease. First you have a very small class
of eases (as far as notification is concerned) in the very early stage which, with suitable treatment
and after-care, may be considered curable. Such cases come under my notice through voluntary
notification. The second class is larger and may be considered to include those which are still in
the early stage or have just begun the second stage, and while not completely curable, still under
suitable treatment can have the disease arrested sufficiently to enable them to follow their employment
many years; and finally you have the third class, including cases in the late second and final
stages. These are incurable and generally past work, and are probably the greatest danger to
their families and neighbours.
Prevention.
(a) General.
In considering this matter there are some measures which would apply to all cases, and other
measures which are only suitable for a particular class. Among the first is systematic visiting.
Each case notified, whether poor law or voluntary, should be visited by a medical man, who would
make careful inquiries as to the origin of the disease and the health of the other members of
the patient's family and advise as to general measures to prevent spread and for the benefit of the
patient. Such would include disposal of sputum, disinfection, sleeping accommodation, ventilation,
sunlight, and also inquiry into the general sanitary condition of the home, abatement of any
nuisance, such as overcrowding, dirt, verminous conditions, &c.: he could arrange for systematic
disinfection, and, in conjunction with the medical attendant, classify the patient in view of any
further measures which might be thought desirable. The case should be followed up by systematic
visits of the Health Visitor at such intervals as occasion requires. She would see that all precautions
and recommendations were being carried out faithfully, and in cases which were being assisted in
any way by the Council that the conditions were complied with. This should be part of the work