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pointed out in my last report, such increase must be expected, as the value
of X-rays increases proportionately with improvements in technique and
experience in the interpretation of films. It must be borne in mind that
their use is not limited to diagnosis—they show also the extent of the disease,
and often enable us to form an opinion on its activity ; such information
is of the greatest value in deciding appropriate treatment. The films also
help us to judge accurately the progress of a case, and are an indispensable
guide in treatment by artificial pneumothorax.
It is still, however, in the diagnosis of early tuberculosis that X-rays are
so invaluable. An X-ray film will often show early infiltration of the lung
before the appearance of symptoms and physical signs, and with its aid we
are able on occasion to diagnose early tuberculosis in a contact where otherwise
it might be missed. Such a patient stands a very good chance of complete
cure, and in my opinion any extra expense involved is justified. Personally,
I would like to have every contact between the age of 16 and 25—the most
susceptible age period—X-rayed as a matter of routine.
The age period mentioned above is neglected by the State. The infant
welfare service and the school medical service between them undertake the
care of children to the age of 14. At the most critical period, as far as
tuberculosis is concerned, young boys and girls go out into the world, often
into unhealthy and unsuitable occupations, with no supervision of any kind.
Should they develop tuberculosis, the natural independence of youth often
deters them from seeking advice until the disease is well established. While
it may be argued that prolonged control of youth by the State is not desirable,
a greater measure of supervision must of necessity be our aim if tuberculosis
is to be wiped out.
The local charitable organisations continue to help us in many ways. The
Hackney and Bethnal Green branches of the Invalid Children's Aid Association
have arranged convalescent treatment for increasing numbers of our
debilitated children at the seaside or in the country. The Charity Organisation
Society and the United Services Fund have assisted in the provision of surgical
instruments, dentures, clothing, etc., and have given financial assistance
in certain cases.
The children attending Stormont House open-air school have made good
progress. As reported last year, the London County Council now admit
" suspect " cases of tuberculosis to this class of school in addition to notified
cases. It was thought that parents of suspect cases might object to their
children working in such close contact with definite cases of tuberculosis.
There has, however, been no difficulty in this direction, as I have been able
to assure the parents that no actively infectious case is allowed to remain
at the school.
The school accommodates 90 children and is always full. As preference
is given to notified cases, any increase in the waiting list does not materially
delay the entry of a tubercular child. With few exceptions all the children
come from the neighbouring boroughs of Bethnal Green, Hackney and Stoke
Newington. Both pulmonary and non-pulmonary cases of either sex are
eligible for admission, and the ages range from 6 to 16. The children are
kept under strict medical supervision, records of temperature and weight
being kept by the nurse, who visits the school daily, while the medical officer
makes frequent examinations of the children and supervises the exercise
and rest of each child. Hot milk, during the morning and afternoon, and
midday meals are provided. The classes are held in open-air shelters, but
ample indoor accommodation is available in case of inclement weather.
We find it is rarely necessary to bring the children indoors, and it is really
astonishing how quickly they become acclimatised to the new conditions,
and, what is perhaps more surprising, how soon they learn to prefer open air
conditions even in mid-winter.