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County Council and by the Guardians. Patients living
at home are under the care of private doctors, outpatient
departments of hospitals or dispensaries.
The co-ordinated measures of the London County
Council and Borough Councils have been fairly
successful and there is now a definite scheme of cooperation
between the different bodies dealing with
tuberculosis. It is the duty of the dispensary to see
that all patients are kept under supervision or treatment
and that no case is lost sight of. The system
at present, however, is complicated and much time is
occupied in correspondence, form filling, and administrative
work generally, which could more usefully be
spent on clinical work. There is a good deal of overlapping
between the central and local arrangements
which, no doubt, will be eliminated in the course of
time and as the result of experience. There is, moreover,
great need to simplify procedure. The fact that
the London County Council and Poor Law schemes are
under separate control is also a difficulty.
Note on the want of accommodation for cases in the
second and third stages.—These may be looked upon
as more or less advanced cases. On account of the
lack of accommodation in institutions for these cases,
they have to be treated at home during the greater part
of the course of the disease. Although it is a difficult
matter in many instances to ascertain the source of
infection in a case of tuberculosis, the disease is certainly
caused in many cases by the patient living in contact
for a prolonged period with another person suffering
from tuberculosis, and it is impossible to take adequate
precautions against infection in the average home.
It has been estimated that approximately 94 per cent,
of cases are due to infection from a human source and
6 per cent, from a bovine source. On investigation of
the histories of the 190 new cases notified for tuberculosis
during the year, 60 were traced to infection from
other members of the family, equivalent to a percentage
of 31•5. It is, of course, impracticable to compel all
patients in the later stages to go to institutions, firstly,
on account of the expense involved, and secondly, on