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Taking these figures for the years 1920 and 1937, he found that less time (by between four and
five months) is now taken by patients in reporting to their doctors; and the latter referred their cases
to the Tuberculosis Officer very much more quickly than formerly. Even so, the percentage of "early"
cases is very small (and taking Fulham as an example and in regard to Dispensary cases—less than
10 per cent.)—a matter which has considerable bearing on ultimate success or otherwise of treatment.
Probably one of the chief reasons why this should be so is that in the majority of cases the
initial symptoms have been so trivial as to escape the patient's notice, or have been disregarded until
something more or less definite has occurred, exciting suspicion individually or from some other
member of the family.
Even when the patient has gone to the private practitioner and received a letter from the
latter to the Tuberculosis Officer, it is by no means rare to find the patient has decided to "wait
and see" how he feels for a few weeks before coming to the Dispensary—no doubt fear of consequences
being a strong factor in such cases.
A moving population is also a difficult class with which to deal—because either patients have
no regular doctor; or they do not stay long enough in one place for proper observation, going away
before sputum test and X-ray can be done.
Although it is true that a diagnosis of tuberculosis is sometimes missed by the doctor at home,
my impression is that in the majority of cases the delay in coming to the Dispensary rests on the
patient—and that the best way to remedy this is by education of the public that symptoms which
persist, even though they may appear trivial, should not be neglected; and that they can always ask
their doctor to have them X-rayed either through the Dispensary or the Out-Patients' Department
of a special hospital, such as Brompton.
I think the National Health Insurance authorities could help in this direction by sending such
advice on a leaflet to all insured patients as other persons in the household could scarcely fail to see it
as well.
The leaflet could also point out the value of immediate and early treatment and that disease
can be cured if taken in time; this would no doubt act as an antidote to the general impression that
there is no hope of cure for patients once the diagnosis is made.
From the administrative point of view there would be more X-ray examinations and hence
need for increased estimates for such services; but I feel sure that most enlightened Councils would
be willing to increase grants for such, having in view the immense importance of early diagnosis both
from the patient's point of view directly, and from the preventive aspect with regard to future infection.
Home Visiting, Supervision and Contact Examinations.
The Dispensary Staff made 4,393 visits during the year, of which number 475 were made by
the Tuberculosis Officer, including visits to patients in institutions and homes, for consultation,
examination or supervision. The Tuberculosis Visitors usually make appointments for contact examinations
at the Dispensary to suit workers or non-workers, as the case may be, and it is much to their
credit that they can persuade so many to attend for that purpose. As usual, the young adult population
is the most difficult with which to deal, but there are signs of improvement even in this direction
—more young workers having come up this year.
X-ray Examinations.
As in previous years, they have been carried out at Brompton Hospital, under the usual
arrangements, 505 having been recommended during 1938.
A large number of cases are also X-rayed (occasionally, several times) whilst in Fulham Hospital,
but the films are retained in the hospital, although it is always possible to get the loan of them if
required later at the Dispensary.