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130
early diagnosis in some instances, and to prevent erroneous notification in
others, thus avoiding the unnecessary examination of " false" contacts.
1 submit at the end of the report a statistical summary of the work
of the Dispensary for the year. Apart from some increase in the total
number of new cases, probably due to the severe influenza epidemic early
in the year, the figures show little variation from preceding years.
The increasing number of cases referred to the X-ray department reflects
the demand of the lay public and the medical profession for this
latest aid to diagnosis. With recent improvements in technique this method
has now established itself; but it should be more generally recognized that
X-rays are by no means infallible, and their indiscriminate use as the
only method of diagnosis is to be deprecated. An appreciable number of
cases is wrongly notified on the evidence of radiologists with little or no
special experience in chest radiology. If X-rays alone are relied on in the
diagnosis of tuberculous disease of the lungs errors will be frequent, as
the correct interpretation of the films requires considerable experience, and
even to the expert it presents many difficulties. If, however, due consideration
is paid to symptoms and the results of clinical examination, the help
we derive from X-rays is always valuable and generally conclusive.
It will be seen that fewer cases have been referred to the Sunlight
department of the Hospital. In previous reports we have drawn attention
to the fact that the results of this form of treatment were not so encouraging
as we had been led to expect. That this has been the general experience
is shown by the fact that in April last the L.C.C. cancelled the provisional
arrangement for artificial light treatment at approved hospitals and other
centres. The Council in their circular letter of February 19th, 1929, state
that "very little use has been made of the scheme by Tuberculosis Officers,"
and that " the reports of these Officers disclose practically no evidence of
benefit having been derived by the patients from this form of treatment,
or of results justifying in their opinion further experimental arrangements."
The letter further states that " the best results are obtained when light
treatment is given as an additional method of treatment under suitable conditions
in residential institutions in the country where all methods of treatment
are available in addition to fresh air, good food, and a regular
regime."
" It is appreciated that there may occur after 31st March, 1929, exceptional
cases of tuberculous persons attending dispensaries who for adequate
reasons will be unable or unwilling to accept residential treatment in a
sanatorium, but for whom Tuberculosis Officers consider light treatment
advisable. The Council would be willing in any such exceptional cases
to consider favourably applications for the approval of light treatment
therefor, on the conditions laid down in, and at one or other of the
hospitals recognized for the purpose of, the experimental scheme."
Four hundred and thirty-two cases were referred for the opinions of
the Tuberculosis Officers by the General Practitioners of the district. Many
of the latter we meet in consultation, and in this way learn to appreciate
each others' difficulties while cementing the friendly relationship and good
will which have always existed between us.
In conclusion I would like to thank the Medical Officers of Health,
the Hospital Physicians and Surgeons, the Resident Medical Officer, and
the Hospital Secretary for their valuable help and advice, and the Dispensary
Staff for their efficient work and loyal support.
(Signed) H. TYLFORD HOWELL.
7th March., 1930.