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50
the very ready help which I have this year, as in the past, received
from Dr. Hebert, the Medical Officer in charge of the Tuberculosis
Department of St. Thomas' Hospital. Such help I have always
found of the greatest value.
"Contacts."
During the past year 290 "contacts" were examined at the
Dispensary. Of the " contacts " examined 90 were adults and 200
children. The value of a single examination of a "contact" child
is apt to be exaggerated, and supervision over a period of years is
required to make this part of the Tuberculosis Scheme really worth
while. It has to be remembered that the infection in childhood is
frequently a latent infection which may light up at any time, more
frequently, perhaps, after some acute illness or other debilitating
influence. A single examination, therefore, when no clinical evidence
of disease is found, may give a false sense of security. Reference
of " contact " children to the School Medical Officer, if systematically
carried out, will provide for the continued supervision
of those children. In addition, the Dispensary Nurses, on their
periodic visits to the homes of Dispensary patients, make enquiries
concerning the other members of the family, and, when their
enquiries lead them to suspect that a further examination of one
or more members may be advisable, they endeavour to persuade
them to return to the Dispensary for re-examination. The prolonged
supervision of "contacts" becomes increasingly more
difficult, and it may become necessary in the future to concentrate
on special families where the history re tuberculosis is a bad one, or
where the home conditions are particularly unsatisfactory.
Total Notifications.
During the year 17 patients in whom the diagnosis was at first
doubtful were diagnosed as definitely tuberculous, and these, added
to the 202 new patients, make a total of 219 notified cases. Of
this number 99 had already been notified to the Medical Officer of
Health, so that 120 were primary notifications from the Dispensary.
Attendances.
The number of old patients attending the Dispensary during the
year was 942. For previous years the number has been:—
1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922
661 971 1,015 1,039 1,090 1,193 1,230 1,250 1,474 1,570 1,026
For the year, the total number of attendances was 5,436, compared
with 4,910 in the previous year. Of those, 1,791 were attendances
of insured patients, and 3,645 of non-insured patients. No
treatment of insured patients is given at the Dispensary save
in exceptional circumstances, but such patients attend the Dispensary
for observation at intervals varying according to the necessity
of the case.