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of the disease and the comparative freedom from troublesome
symptoms are responsible in many cases for the failure of patients
to seek medical advice when the disease is still in an early stage.
The true significance, however, of even a small hæmoptysis or of
pleurisy with effusion as probable evidence of Tuberculosis is not
yet sufficiently appreciated by some of the medical profession.
With regard to the early diagnosis of Tuberculosis much assistance
in the way of X-ray examinations, &c., has, as in past years, been
received from St. Thomas's Hospital, with which the Tuberculosis
Dispensary is closely linked as part of the Tuberculosis scheme of
the Borough.
Institutional treatment is provided by the London County
Council and the majority of patients who have been recommended
for such treatment have been accepted. In some advanced cases,
however, the Council has reported its inability or unwillingness to
provide residential treatment and when the patient is unwilling
to go to the Poor Law Hospital he must needs remain at home—
a source of infection often to the other inmates. During 1928,
137 patients were sent away for institutional treatment by the
London County Council. Of this number 32 or approximately
23 per cent. took their own discharge. It is a well known fact
that many Tuberculous patients are quite unsuitable temperamentally
for residential treatment,and this applies more particularly
to the more advanced cases. The majority of patients who take
their own discharge come from the type of institution which admits
the advanced case. From King George V. Sanatorium, Godalming,
and from Pinewood Sanatorium comparatively few patients take
their own discharge. The problem of finding employment for the
ex-sanatorium patient who as a result of his Sanatorium treatment
or otherwise has lost his occupation remains as difficult as ever.
In the present state of the labour market it is almost an impossibility
to find such patients suitable work. The consequences of this, both
from a mental and from a physical point of view, are definitely
harmful. It is gratifying, however, to be able to report that many
employers readily assist patients to recovery by assuring them
that their posts shall be kept open for them pending their return
from Sanatorium.
Artificial pneumo-thorax treatment is of great value in the
treatment of certain types of Pulmonary Tuberculosis. An increasing
number of Dispensary patients now receive this form of
treatment. Treatment is commenced in Sanatorium and continued
at Brompton Hospital or St. Thomas's Hospital on the patient's
return, or the whole course is carried out at one or other of those
hospitals without sending the patients to a residential institution.
In one Dispensary patient the operation of thoracoplasty was
carried out at Brompton Hospital during 1928. Many school
children who are "Contacts" of a Tuberculous patient are referred
to the School Medical Officer for observation and "delicate"
children who attend the Dispensary for examination are similarly