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account of the harshness of such a proceeding. A rapid
decline in the tuberculosis death rate is not, however,
to be expected until the most obvious cause of the
spread has been removed. The chief difficulty at
present is that most of the accommodation available
for advanced cases is in infirmaries, and many persons
refuse to go to a Poor Law Institution. Alternative
accommodation, near enough for friends to visit frequently
and sufficiently attractive to induce patients
to remain, is much needed.
Home visiting and examination of contacts.—5,447
home visits were made by the nurses during the year
under review. The chief objects of the visits are to
keep the home under supervision and to see that curative
and preventive measures are carried out. A general
idea of the economic, social and financial circumstances
is obtained by the nurse, so that if help is necessary
the case can be reported to the Care Committee.
A knowledge of the home circumstances is of great
assistance in the treatment of the case and also from the
public health point of view. During 1922, 73 houses
were dealt with by the Medical Officer of Health on the
recommendation of the Dispensary staff.
The visiting ensures that the Dispensary keeps
in touch, not only with the patient but with other
members of the family, or contacts. This is especially
important if the case is one discharging tubercle
bacilli in the sputum and such cases are visited more
frequently than those which are not infectious.
As regards the routine examination of contacts, 409
examinations were made and 34 contacts were advised
to attend as patients. The number of contacts found
to be tuberculous on first examination is very small,
as prolonged and intimate contact is necessary unless
there is a diminution of specific resistance such as is
probably the case in certain families. Active signs
may not develop until some years after the original
exposure to infection, and it is advisable in many cases
to re-examine contacts at intervals.
The Care Committee.—The Dispensary is fortunate
in having so many experienced workers on the Care