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69
It happens sometimes that the patients cease their attendance at the Dispensary before the
Tuberculosis Officer can come to a definite opinion. This failure to attend is frequently due to the
fact, in the first class of case, that the patient feels perfectly well and sees no object in occupying
his time in attending the Dispensary for further examination, and, in the other two classes, because
the illness from which the patient was suffering may have apparently cleared up.
These patients often do not realise the importance of allowing the Tuberculosis Officer to
complete his diagnosis.
When a "suspect" has failed to keep an appointment, he is visited at home by a Woman Health
Officer, who gives him a definite appointment with the Tuberculosis Officer at the Dispensary so
that he will not be kept waiting. If he fails to keep this appointment, second and third visits are
paid for the same purpose, when, if of no avail, the case is dropped for the time being.
During the year 9 of the suspects were finally discovered to be suffering from respiratory
and 4 from non-respiratory tuberculosis. With the exception of 27 cases remaining under
observation at the end of the year and 15 cases who failed to visit the Dispensary for further examination,
the remainder were proved to be non-tubercular.
It may seem unfortunate that so much time has been wasted on those 15 patients who ceased
to attend despite the visits paid to their homes by the Health Officers, but this work is by no means
lost because the patients have become familiar with the Dispensary Officers and know full well that
they can attend without delay if in the future their health seems doubtful.
Arrangements for Securing the Examination and Systematic Supervision of Home Contacts.
Persons most likely to be found to suffer from tuberculosis are those who have been in contact
in the home with an infectious case and thus the importance of the examination of all " home
contacts " is obvious. This examination does now and then discover a definite and hitherto
unsuspected case with its possibilities for evil both to the sufferer and to the family, and it makes the
earlier treatment of such a case feasible with all that that implies in obtaining a favourable result.
The benefit, however, is not limited to these definite cases as it also teaches the fact of the infectiousness
of a case, even when no other sufferer is discovered, and thus serves to educate the
family and at the same time to encourage the seeking of advice should any suspicions be subsequently
aroused.
Special efforts are made to secure the examination of all " home contacts " of notified cases.
Every " home contact " is visited at the home at least three times if necessary by the Health Officer
with a view to inducing him to attend the Dispensary.
Perhaps one of the most encouraging features of the work is the steady rise in the number of
home contacts " examined year by year in relation to the number of cases notified.
Five or six years ago Sir William Hamer, who has recently retired from the office of County
Medical Officer, estimated that Dispensary records should show the examination of 2.5 contacts
for every notified case of tuberculosis if the contact work were being efficiently carried out. At
that time under 20 per cent, of the contacts, based on this proportion, were being examined in this
Borough, but since then a very vigorous attempt has been made to bring up the percentage to 100.
Indeed, no branch of the Council's Tuberculosis Scheme has received more close attention than this.
The figures for 1925 are therefore, satisfactory, for whilst there were 292 notifications of
tuberculosis, 396 contacts were examined at the Dispensary and 109 were known to
have been examined elsewhere, which shows, according to Sir William Hamer's estimate, that 61
per cent. of the " home contacts " were examined.
During the year 177 other " home contacts " Were visited but refused to be examined after
repeated offers.
The endeavour to secure a second examination of " home contacts " of infectious cases after
approximately one year's interval, especially young adult cases whose age renders them more
vulnerable, which was definitely systematised last year, has been continued and the number of these
examinations, apart from the 396 contacts mentioned above, was 111. Any cases the least suspicious
or with a bad family history are further supervised.
Dental Treatment of Tuberculosis.
In 1920, the Council approved a scheme for the dental treatment of tuberculous persons and
in that year a dental clinic was instituted upon the premises of the Tuberculosis Dispensary.
This scheme provides for the dental treatment of both notified and suspected cases of tuberculosis.
No charge is made for such treatment with the sole exception of cases in which dentures
are provided. In these an assessment is made by the Tuberculosis Care Committee in accordance
with the financial circumstances of the patient.