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A card containing precautionary instructions will be left with the
patient or relatives. Where possible disinfection will be carried out on
the death or removal of a patient " This proved to be ineffectual
as only some 56 cases per year were notified under this system, and a
quarter of these refused visits by the inspectors. The Public Health
(Tuberculosis) Regulations of 1908 brought an improvement in notification
rates, although compulsory notification was restricted to medical
officers of poor law institutions, and district medical officers who were
only concerned with the poor. As a result of the Public Health (Tuberculosis
in Hospitals) Regulations 1911 and the Public Health (Tuberculosis)
Regulations, 1911, pulmonary tuberculosis became fully notifiable,
and in 1912, 344 fresh cases were notified. It was estimated that
this number represented about a third of the persons in the Rorough
thought to be suffering from pulmonary tuberculosis at the time.
The notifications were followed by a visit to the homes of the
patients by the women public health inspectors (there were two employed)
who found that many of the patients were sadly ignorant of the
precautions which they should have adopted for the protection of other
occupants of their homes. Further, many of the sufferers could only
afford occasional medical treatment locally and others were in attendance
at one or other of the London hospitals as out-patients. In 1911 the
Medical Officer of Health requested the establishment of a central
tuberculosis dispensary in the Borough and for more places to be made
available in sanitoria. The Medical Officer of Health's views received
powerful support in 1912 by the Astor committee which recommended
inter alia the establishment of tuberculosis dispensaries and of sanitoria
and hospitals throughout the country.
A tuberculosis health visitor was appointed in 1914, and a second
in 1915, and in June 1916 a tuberculosis dispensary in Catford Hill was
opened with one tuberculosis officer, one clerk-dispenser, and two health
visitors. In the first three years of its operation the tuberculosis dispensary
sent 1097 reports to public authorities and 213 reports to
practitioners, the volume of work increasing each year. The number
of attendances at the dispensary in 1919 was 2,379 and the two tuberculosis
health visitors made a total of 2112 visits to cases in that year.
The medical Officer of Health reported in 1919 that "the interim
tuberculosis care committee have given useful help in many directions
in spite of having been obliged to carry out its functions with insufficient
funds and assistants. There is great scope for the activities of a representative
care committee with ample funds at its disposal". The interim
tuberculosis care committee became a committee of the Lewisham
Borough Council in 1923, and the value of its work cannot be over
emphasised. It discussed the requirements of tuberculous patients and
it assessed the amount of payment towards institutional treatment.
Members of the committee visited patients' families, arranged convalescence,
made grants of milk; helped to find suitable employment,
and assisted with clothing, among many other things, to help ease the
lot of tuberculous patients and their families. A handicrafts class was
started at the Dispensary in 1926 and proved most beneficial as occupational
therapy.