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

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Fulham 1927

Annual report of the Medical Officer of Health for the year 1927

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54
is early or intermediate that one can be certain of
securing a bed, and in many cases one refrains from
recommending a patient with advanced disease because
one knows that he does not come within the category
of cases likely to be admitted. The latter course of
action is adopted because the situation which arises on
the refusal of a patient is in several respects unsatisfactory,
and more especially for two reasons:—(1.) The
moral effect upon a person of not being accepted may
quite easily be severe since it brings home to him,
perhaps for the first time, the knowledge of the dangerous
and possibly hopeless outlook of his illness. (2.)
The prestige of the Dispensary is liable to suffer as the
Tuberculosis Officer has to confess both to the patient
and his friends and also to his doctor that he has been
unable to effect the object for which, in most of the
cases, the patient has been referred to him, namely, to
arrange for his removal from home for treatment. In
fact from every point of view the question of dealing
satisfactorily with advanced and active disease in patients
who, in many cases, are bedridden, is the most difficult
one that confronts us at the present time. It seems
difficult to imagine that any rapid progress towards the
solving of the greater problem, the eradication of tuberculosis,
can be made while so many foci of infection
are thickly scattered amongst a susceptible population.
At the present time the accommodation for advanced
cases is undoubtedly inadequate. The London County
Council provides a certain number of beds for this
purpose but disclaims the responsibility of removing
from their homes all infectious persons and, in fact,
does not guarantee to provide treatment at all unless
the patient recommended shows some prospect of a
definite degree of recovery, if not of cure. During
1927, out of 82 persons on the Dispensary Register
who died, the death occurred in 58 in Fulham Hospital
or at the patient's home, and in 18 in London County
Council institutions, the remaining 6 being in voluntary
hospitals or at the houses of friends or relatives. However,
it would, I think, be a mistake to assume that all
these people would have been willing to go to institutions
at a distance from Fulham had such been