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observation at the dispensary are found to be such, and the children whose
general health is not satisfactory, are transferred to the school medical
department. The Tuberculosis Officer sends a special report on each case
to the School Medical Officer, who arranges for periodical examinations,
weighing, etc. Should the School Medical Officer later suspect tuberculosis in
any of these children, the case is immediately referred back to the dispensary
for an opinion. The School Medical Officer and the Tuberculosis Officer also
meet once a year to discuss these cases and decide whether further observation
of each case is necessary, and, if so, whether this should continue at the school,
or the child be referred back to the dispensary for a period.
One hundred and two cases were admitted through the London County
Council to hospital or sanatorium during the year. The period between the date
of recommendation and that of the patient's admission is still longer than is
desirable, but not so great as formerly. While it is usually possible to obtain
institutional treatment for the early case, it is seldom one can do this for the
moderately advanced or advanced patient, except in the case of the pensioner.
It is only in a few instances that we can persuade those suffering from advanced
disease to enter the infirmary, with the result that they remain at home, possibly
sharing the same bedroom as other members of the family, and perhaps ultimately
infecting them. Until more attention is paid to the advanced case, and more
congenial and better-situated homes within easy distance of their friends are
provided for them, little progress will be made towards the eradication of
tuberculosis. In this connection lam pleased to learn that one of the charitable
societies is considering the question of providing a local institution for such cases,
and it is hoped that something may be done in the near future.
The question of obtaining suitable employment for patients discharged from
residential institutions after a course of treatment has always been a difficult
one. The Ministry of Health, after consultation with the Ministry of Pensions
and the Ministry of Labour, issued a circular in December, 1923, indicating a
line of procedure to be adopted in order to facilitate the provision of suitable
occupations for tuberculous men. Among other things the Tuberculosis Officer
is asked to communicate with the local employment exchange, giving information
as to the kind of occupation desirable in each case. Up to the present we have
not found the results of this scheme to be very encouraging. This opinion is
evidently general, as the London County Council has now issued a circular
suggesting further alterations in procedure. It is pointed out that the objection
to the employment of tuberculous persons is " the fear of infection, and the
reluctance to engage a 1 hand' that may not be capable of an average day's work,
or may have to be off work frequently." To meet the former objection the
Tuberculosis Officer is asked to give to each patient seeking work a certificate
which should indicate that the holder, if his sputum is free from tubercle bacilli,
and if he has shown no signs or symptoms for five years except such as are
compatible with a completely healed lesion, need no longer be regarded as suffering