View report page

76
Of the cases entered on the dispensary register previous to 1936, 90 were removed as
recovered, and 52 owing to the death of the patient during the year. Of the cases arising during
1936, 19 or 15 per cent., died within twelve months of coming under the scheme.
The dispensary is a centre for reference of doubtful cases for investigation, and a number of
cases came to it during the year on their own accord, or were referred by medical practitioners or
by the various agencies in the area.

In the diagnosis and supervision of the disease there are, in addition to clinical investigation,
certain laboratory facilities for the examination of specimens. These are carried out at the council's
laboratory, and during the year 472 specimens of sputum, etc., were examined.
In recent years the diagnosis and control of the disease has been measured with greater
accuracy owing to the advances in radiography. X-ray facilities are provided by arrangements
with the London county council, at St. Mary Abbots and St. Charles Hospitals, and during the
year 516 radiological examinations were made.
There has been an increase in the use of the radiological methods during the year as compared
with 1935, when 190 X-ray examinations were carried out.
The X-ray films are sent from the two hospitals to the dispensary where they are interpreted
by the tuberculosis officer in conjunction with the clinical findings in each case. Where the interpretation
is carried out by the tuberculosis officer the charge to the borough council has been reduced
to 2s. 6d. as compared with 7s. 6d. in previous years. It is now a well-recognised fact that it
would be entirely wrong to discharge patients from the dispensary, or to give a definite opinion
of the progress of a case, without having an X-ray investigation.
A large number of the cases coming to the dispensary are ultimately diagnosed as nontuberculous
and are referred back to their own doctors or referred to other institutions for further
investigation and appropriate treatment.
During the year 68 cases were added to the dispensary register because of their removal into the
borough, as compared with 34 cases in 1935, whilst 75 cases were removed from the register because
of their transfer out of the district. This characteristic of the population in this area has already
been noted as a difficulty in maintaining the supervision of the cases and of their home contacts.
The examination of contacts of known cases of tuberculosis has been one of the important functions
of the dispensary service since its commencement. A contact is a person who has been living
in contact with a known case of tuberculosis, but need not necessarily manifest symptoms.
The growth of the school medical section and of the infant welfare branch of the public health
service has been a decided asset in keeping the child population under supervision, including the child
contacts of known cases of tuberculosis. As a result of the knowledge that their children have been
examined at school or a welfare centre it is occasionally difficult to persuade the parents to bring
the children to the dispensary for a special examination, but on the other hand, the school and infant
welfare medical officers readily refer doubtful cases, especially contacts, to the tuberculosis officer
for investigation. There is no doubt that the efficiency of these services is to some extent responsible
for the reduction in the incidence of the disease in the child population.
There is a very useful part to be played by the dispensary service in the examination of contacts,
who are young adults and persons in the older age groups. Great difficulty is found in persuading
the young adults to submit to this examination when they consider themselves fit and well, but
many visit their respective medical practitioners under the insurance acts.
It was ascertained that there existed 366 contacts of the new cases arising in 1936, and of these,
150 were examined at the dispensary ; 51 by their own doctors ; 11 by school medical officers;
16 by medical officers at infant welfare centres, and 10 at various hospitals ; 128, or 35 per cent..