View report page

38
The inquiry not being yet complete, it is not at present intended
to make much comment on the information above given,
but sufficient data has been collected to show that if any progress
is to be made towards stamping out Tuberculosis in the Borough
much anxious consideration must be given to several points, of which
the chief are—
(а) Provision of accommodation for advanced cases.
(b) The home condition of the patients, including the
tion of contacts.
(c) The earlier notification of the disease.
(d) The development of After-Care.
With regard to the first point, little exists at present, except
the workhouse. It is hopeless to look for much improvement when
advanced cases are allowed to come into such intimate contact with
young children as they do in the average household. Doctors and
nurses may be ever so conscientious in their visits to the homes
and their directions as to the prevention of infection, but with the
habits and conditions prevailing in the ordinary working-class
home it is very unlikely that this is ever fully carried out, and
even when it is, the advanced consumptive is an ever-present danger.
Proof of this will be found below, where 16 per cent, of the contacts
examined this year were found to be tuberculous. Even in the
earliest times this danger was recognised. For example, Galen
wrote, "It is dangerous to live with consumptives, and with those
whose foul breath imparts a heavy odour to the room in which they
lie."
As to the home conditions, little can be said in view of the
existing shortage of houses, but it is hoped that the present method
of sub-letting will be considerably altered, and that no person will
be allowed to sub-let without a licence. Too frequently, subletting
leads to gross overcrowding and to the spread of infection.
No licence should be granted to any known consumptive household.
In connection with the third point, that of earlier notification'
it is to be regretted that many notifications are received too late
to be of much use. Early notification is essential in the interest of
the patient, as it gives him a better chance of recovery by receiving
earlier appropriate treatment. It is also essential in the interest
of the public, because it must be remembered that notification is the
only means whereby the Public Health Department obtains information
as to the existence of infection. Early notification means,
therefore, early action in preventing the spread of infection by means
of the disinfection of the home, the examination of contacts, etc.
To illustrate this point I have analysed the death-notification interval
of 120 patients who died in the Borough in 1920 from Pulmonary
Tuberculosis. The result should give rise to some thought.