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difficult to approach. The servants in many such cases never inform the
family of their complaint, since some mistresses would refuse to employ
a servant known to be tuberculous, and it is not always easy to secure
an interview or get them to attend at the Dispensary.
Public Health Act, 1925, Section 62, and a local Home for
Advanced Cases of Pulmonary Tuberculosis.
This Section does not apply to London, and in consequence to this
extent the Metropolis is not armed with the same power as extrametropolitan
Authorities for securing the compulsory removal to
hospital of cases of pulmonary tuberculosis; neither have we powers
under any other Act approaching those contained in this Section. This
matter will need consideration when the Public Health (London) Act,
1891, is amended.
Pending any such addition to our powers, the best course appears
to be to attempt to persuade advanced infectious cases to consent to
removal from their homes. Especially is this desirable when the home
is a one-roomed or two-roomed tenement.
A Home for advanced consumptives, which, in my opinion, is
highly desirable, should however be such that compulsory powers
ought not to be needed. Hitherto our difficulty has been that the
patient in advanced stages of consumption is not willing to go to or
content to stay in a large Institution that is situated far from home
and friends. Institutions of this kind, if too large, are most
depressing and disconcerting to the patients. The solution appears to
me to be in small, home-like establishments which shall be within
reach of the family and friends, where, if necessary, not only dying
people should be admitted. The majority of our dying consumptives
go at present to New End Hospital; this brings them under the
jurisdiction of the Board of Guardians, and the control of the
Medical Officer of Health is therefore lost. Until these cases are
brought under the jurisdiction of the local sanitary authority and
under those responsible for the control of tuberculosis, no scheme can
be said to be perfect. Strong endeavours have been made to secure
such a building for such a purpose during the past three years, but no
suitable building has yet been discovered, though efforts are still being
made.
The number of deaths in recent years from pulmonary tuberculosis
have ranged from 41 to 75 per annum. The number of these that can
be said to be in a dying state at any one time is from 8 to 10, and