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115
TUBERCULOSIS DISPENSARY.
REPORT FOR THE YEAR
By P.L.T. BENNETT, M.C., M.R.C.S., L.R.G.P.. D.P.H., T.D.D.
Tuberculosis Officer and Medical Officer, Borough Bacteriological Laboratory.
Staff Changes. Owing to the absence of the Tuberculosis Officer, who was Acting Medical
Officer of Health at the Town Hall for nine months during the year, two Locum Tenens
officers were appointed to carry on the Dispensary work. Dr. Harley Stevens acted in this
capacity from January to July, after which time, owing to his appointment to a permanent
post in another borough, the work was taken over by Dr. Gregory Kayne until October.
The part-time clerk, Miss M.. Wright, resigned in May, and Miss D. Grimstone was
appointed in her place.
Routine and Statistics. There was no change in the Dispensary time-table during the
year; and, notwithstanding the change of officers, always a matter of difficulty as regards
continuity of service, the work of the department has been well maintained.
As in the preceding year six routine fixed sessions for men, women and children were
carried out during the week; in addition, one session was devoted to consultation work in
Fulham Hospital and a weekly visit was made to the Elizabethan School.
Special appointments were as usual given to patients not able for various reasons to
attend the ordinary sessions; and a morning and afternoon were usually set apart for visiting
and outside consultations with practitioners.
A good deal of clerical work in connection with reports on patients is always necessary
in a department dealing with many different authorities, and this has, as usual, been carried
out when time could be arranged conveniently.
Regulations formulated by the Ministry of Health to a large extent govern or direct
procedure in tuberculosis dispensaries, and are designed to create a system which is uniform
throughout the country and to ensure that the categorisation of disease and statistical returns
of the same are both comprehensive and comparative.
The summary of our tuberculosis statistics, given at the conclusion of this report, show
under most headings a slight decrease as compared with those of 1934. This decline is partly
due to various "local" factors which vary annually (chiefly as regards movements of the
tuberculous population, staff changes, etc.), and partly to an epidemiological decline in
incidence and mortality which has been recognised during the past fifty or sixty years. More
complete knowledge of the disease and its infectivity together with improved hygienic
conditions, better housing, higher wages and consequently improved nourishment, are all
factors which have also had a responsible share in this decline.
There is still a "long way to go," however, and a disease which has a mortality figure
of nearly 30,000 per annum for England and Wales, can still only be described as very fatal.
The examination of all family Contacts is urged by the Dispensary Staff with varying
success. A fair proportion do eventually come up to the clinics, but many are no doubt scared
of being found tuberculous, and prefer to "carry on and trust to luck," and it is often rather
difficult to persuade people who feel quite fit and have no symptoms of illness at all to submit
themselves for examination.
That so many do come must be attributed in a large measure to the perseverance and
tactful persuasion of the Nursing Staff on their home visiting.
X-ray Examinations. Under arrangements made between the Borough Council and the
Brompton Hospital for Consumption, cases for X-ray examination are sent by appointment
to that Institution. During 1935, there were 350 patients so referred, though it should be
understood that a large number of additional cases are frequently "X-ray-screened" whilst
having refill treatment for artificial pneumothorax.
The use of X-rays is becoming increasingly valuable in connection with the work of the
Tuberculosis Dispensary, and we are fortunate in being able to refer our cases to the X-ray
department at Brompton.