London's Pulse: Medical Officer of Health reports 1848-1972

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Bermondsey 1928

Report on the sanitary condition of the Borough of Bermondsey for the year 1928

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3. The Tuberculosis Officer. An efficient, full time
Tuberculosis Officer, backed by a capable dispensary staff, should
be the mainstay of the tuberculosis scheme. It is essential for
him to have at his disposal all possible aids to diagnosis and,
ideally, he should have control over a certain number of beds,
some for the purposes of observation and some for cases needing
immediate treatment prior to admission to sanatoria in the
country.
The examination of contacts provides opportunity for the
detection of early cases, and during the year a system was started
on the lines described by Doctors E. L. Opie and F. M. McPhedran
of the Henry Phipps Institute, University of Pennsylvania. In
the "march past" which is usually held soon after the notification
of a case of tuberculosis comparatively few new cases are discovered,
but there are many families in Bermondsey, and probably
in other districts, where subsequent cases have occurred after the
lapse of months or even three to five years. Memorandum
121/T, issued by the Ministry of Health in 1926, states that 'many
persons suffering, or suspected to be suffering, from tuberculosis
who attend at the dispensary of their own accord, or who are
referred by a private medical practitioner, may give a history
of previous contact with a known case of tuberculosis; but this
does not render them 'contacts' for the purpose of Table 1., and
they should be regarded as new cases.' As a result of this regulation
the number of positive contacts in all districts is low and the
amount of infection in the home is held to be small. Opie and
McPhedran carried out their investigation by charting all the
members of a tuberculous family and followed them up over a
number of years. Diagram II. has been drawn up to show the
method and illustrates the history of a family in Bermondsey.
A full description of the cards and of the conclusions reached by
Opie and McPhedran will be found in the 19th Report of the
Henry Phipps Institute, 1927. An effort will be made to follow
up contacts over a number of years and it seems likely that this
will aid in the detection of cases in an early stage of the disease.
In Diagram II. are shown two deaths from tuberculous
meningitis and in Table III. are set out all the deaths from tuberculosis
in children for the year with particulars of contacts.