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66
Of the cases entered on the dispensary register previous to 1937, 38 were removed as recovered
and 49 owing to the death of the patient during the year. Of the cases arising during 1937, 32 or
13 per cent. died before the end of the year.
The dispensary is also a centre for reference of doubtful cases for investigation, and the majority
of the new cases were referred by general practitioners ; others were sent by school medical officers
and the various charitable institutions. A certain number, who had no private doctor, came of
their own accord.

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 715 specimens of sputum, etc., were examined.
In recent years the diagnosis and control of the disease has been measured with greater accuracy
owing to advances in radiography. X-ray facilities are provided by arrangement with the London
county council, at St. Mary Abbot's hospital and St. Charles hospital, and during the year 768
radiological examinations were made.
There has been a considerable increase in the use of radiological methods during the year as
compared with 1936 when 516 X-rays were carried out and a still greater increase as compared with
1935 when 190 such examinations were made.
The X-ray films are sent from the two hospitals to the dispensary where they are interpreted
by the tuberculosis officer in conjunction with his clinical findings in each case, as this is an arrangement
which is generally recognised as more valuable than the separate opinion of a radiologist
who has not the benefit of being able to correlate the results of the physical and radiological
examinations.
A large number of the cases coming to the dispensary are ultimately diagnosed as non-tubercular
and are referred back to their own doctors or to other institutions for further investigation and
appropriate treatment.
During the year 75 cases were added to the dispensary register because of their removal into
the borough, as compared with 68 cases in 1936; whilst 110 cases were removed from the register
because of their transfer out of the district. This tendency to migration has already been noted
as a difficulty in maintaining the supervision of the cases and of their home contacts in this area.
The examination of contacts has been one of the important functions of the dispensary service
since its commencement. A contact is a person who has been living or working in close association
with a known case of tuberculosis, but who does not necessarily manifest symptoms.
The growth of the school medical service and of the infant welfare branch of the public health
department 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 at 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.
It was ascertained that there existed 454 contacts of the new cases arising in 1937, and of these
237 were examined at the dispensary, 42 by their own doctors, 6 by school medical officers, 20 by
medical officers at infant welfare centres and 15 at various hospitals; 134 or 34 per cent. failed to
undergo an appropriate examination. Of the total number of contacts examined at the dispensary
during the year 7 were found to be suffering from tuberculous disease.
During the year 3,395 visits were paid by the women health officers. Since 1st April, 1937,
two whole-time tuberculosis health visitors have been assigned to this work instead of as in the past