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Of the cases entered on the dispensary register previous to 1938, 34 were removed as recovered
and 55 owing to the death of the patient during the year. Of the cases arising during 1938, 25
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 investigations
certain laboratory facilities for the examination of specimens. These are carried out at the council's
laboratory, and during the year 783 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 radiology. X-ray facilities are provided, by arrangement with the
London county council, at St. Mary Abbots hospital and St. Charles hospital, and during the
year 648 radiological 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; this is an arrangement
which is generally recognized 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 examination.
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 62 cases were added to the dispensary register because of their removal into
the borough, as compared with 75 in 1937, and 154 cases were removed from the register because
of their transfer out of the district. This tendency to migration creates 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 advantage 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 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 332 contacts of the new cases arising in 1938, and of
these 186 were examined at the dispensary, 41 by their own doctors, 4 by school medical officers,
5 by medical officers at infant welfare centres and 8 at various hospitals; 88 or 27 per cent. failed
to undergo an appropriate examination.
During the year 3,536 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 each health visitor of the council having a district in which she was responsible for the whole
of the health visiting. The new arrangement allows the two health visitors to specialise in the
tuberculosis visiting and leads to a greater interest in the tuberculosis service than was possible
under the former arrangement when the visitor had so many other calls upon her time. It also
allows closer co-operation between these visitors and the clinical tuberculosis officer, who accompanies
them on many of their visits