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APPENDIX II.
TUBERCULOSIS DISPENSARY.
REPORT FOR THE YEAR 1933.
By H. Tylford Howell, M.R.C.S., Eng., L.R.C.P., Lond.,
Clinical Tuberculosis Officer.
For the seventh year in succession there has been no change in the personnel
of the Dispensary. I have to report, however, that I was off duty for four
months during the year, owing to illness, and I would Like to take this
opportunity of thanking the Committee for their sympathetic consideration
during this period. Dr. Dowling assumed charge of the department, and I
am grateful to him for the able and conscientious manner in which he carried
on during my absence. He was able to do this the more readily and without
any undue anxiety, as he was acquainted with every case. Our usual practice
of consulting one another on most cases and discussing any special features
and points of difficulty enables either Tuberculosis Officer, in an emergency,
to take over entire charge of the department without the patients suffering
in any way.
No radical alteration in the routine of the department has been introduced
during the year and the sessions have remained the same.
Patients are seen on Monday, Wednesday, Thursday, Friday and Saturday
mornings from 10 to 12 o'clock ; Wednesday evenings from 5.30 to 7 ; and on
Thursday evenings from 7.30 to 9 o'clock. Saturday mornings are reserved,
as far as poasible, for school children, and the evening sessions for those who
are at work during the day, but these reservations are not strictly adhered to
if it is found inconvenient for any particular patient to attend during one of
the morning sessions. Patients may attend during any part of the session,
and are seen strictly in order of their arrival at the Hospital, irrespective of
whether they are new or old cases. This arrangement reduces the period of
waiting to a minimum.
We continue to take advantage of our close association with the hospital
in referring difficult cases for special opinions to the Physicians and Surgeons
or to one of its special departments. We appreciate especially the facilities
for personal interviews with the hospital staff, which enable us not only to
discuss individual cases but to keep in touch with other opinions generally
and to see other work.
The number of cases referred to the X-Ray Department again shows an
increase. This is only to be expected, as frequent improvements in technique
have added considerably to the value of X-rays, not only in the detection of
early tuberculosis, but in other directions also. Early infiltration of the lung
may often be demonstrated by X-rays before the appearance of any physical
signs, so that we cannot neglect to take an X-ray picture of any case whose
symptoms suggest possible tuberculosis. It must not be forgotten, however,
that occasionally a patient may have definite physical signs of disease with a
positive sputum while the X-ray picture may fail to show any evidence of
tuberculosis. The present tendency, therefore, to minimise the importance
of routine physical examination and rely entirely on X-rays should be resisted,
as the neglect of either method will result in failure to detect tuberculosis in
certain cases and in erroneous diagnosis in others.