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98
employment for tubercular men has completely failed. I would again like
to advocate the desirability of the adoption of local workshops, subsidized by
the State or Local Authority, where men could work at suitable occupations
under direct medical supervision and obtain a living wage. The only "real
objection to such a scheme appears to be the question of expense, but surely
it would be less costly to the State than continuous unemployment, and
certainly better for the patients.
The scheme for the supply of extra nourishment adopted by the Boroughs
in 1921 still operates. The number receiving benefit is necessarily small, as
the expenditure sanctioned must not excced £2 per 1,000 of the population.
The additional diet given takes the form of milk and eggs, and undoubtedly
it has considerably helped those patients who, on leaving sanatorium, are
unable to provide suitable nourishment for themselves pending their return
to work.
I continue to act as Honorary Consultant to the Bethnal Green Hospital,
visiting the institution once weekly. I see all doubtful cases and am thus
enabled to reduce the number of notifications and consequently save the
unnecessary visiting and examination of contacts.
In September 1925 the Ministry of Health issued a Memorandum as to
the Annual Returns to be furnished by the Chief Administrative
Tuberculosis Officers of Local Authorities, and as to the records kept bv
Tuberculosis Officers. The memorandum states that, for the purpose of
ascertaining the extent and estimating the value of the work done under the
approved schemes of Local Authorities for the treatment of Tuberculosis, and
of obtaining a uniform presentation of the facts for the country as a whole,
it is necessary that more complete and systematic information should be
furnished to the Ministry than has hitherto been sought from Local
Authorities. Returns in the form of tables are therefore required, and from
the 1st January, 1926, Tuberculosis Officers were requested to keep such
records as may be necessary to furnish such reports.
The completion of these forms has meant a considerable increase in our
clerical work. Some idea of its extent may be conceived if I mention that
one table requires in summary form the condition of all patients whose case
records are in the possession of the Dispensary at the end of the year,
arranged according to the years in which the patient first came under Public
Medical treatment for Tuberculosis, together with their original classification.
While no doubt some useful information may be gleaned from these reports,
they contain a great deal of which the usefulness is doubtful. As an
instance of the latter I would mention that even the negative cases have to
be classified into Adults, male and female, and Children, male and female.
The tables, moreover, are so ambiguous and difficult of interpretation that
the figures in many instances are liable to be misleading.
I submit at the end of the report a statistical summary of the work of
the Dispensary for 1926. The figures in some instances have been
considerably affected by the recent memorandum. The drop in the number
of contacts I think can be entirely accounted for in this way. Previously it
was our custom to regard any patient who had been living with a definite
case of tuberculosis, irrespective of the origin of his attendance at the
Dispensary, as a contact. It is now laid down that only those cases which
attend the department as the result of the Tuberculosis Scheme should be so
regarded. Cases sent by doctors and patients who attend voluntarily are
not to be entered as contacts, notwithstanding the fact that they may at the
moment be living with an infectious case of Pulmonary Tuberculosis.
Prior to 1926 a case was not discharged from the register, even if no
evidence of tuberculosis was found, so that if he attended the department
again after a lapse of several years he retained his old number and was