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double the tuberculosis notifications.
During this year a special weekly session has been arranged for the investigation of
the problems of asthma, and allergic conditions affecting the respiratory tract.
CHEST CLINIC, DEPTFORD
I am indebted to Dr. J. P. V. Rigby for the following report concerning the Chest
Clinic at Harton Street of which he is consultant physician:
Though pleasure should rightly be expressed if the number of individuals dying
from tuberculosis is decreased, I am not so sure that one should look forward to a
decrease in tuberculosis notification without caution.
If the case-finding services are proceeding at full tilt, then all is well if a drop
occurs. But the fight may not be sufficiently sustained if this clinic is moved two miles
away into the new Greenwich District Hospital. Such a move may impair our contact
with known tuberculosis cases in North Lewisham, still 1,097 in number, to
vanishing point. Carrington House, the nearby lodging house, at present furnishes
us with many of our cases of tuberculosis, new and old. If this clinic moves far away
from Carrington House, I think that all our carefully built-up contacts with these
men may virtually cease. They will not, in my view, come two miles into Greenwich
for treatment.
The mass radiography unit does yeoman service every six months in visiting
Carrington House, but speaking from the receiving end I know that, despite their
efforts, on average only 100 or so of the total potential of 734 inmates actually get
an x-ray done, and some of these are already known to me and attending the clinic.
A significant percentage, though detected, disappear even before this clinic can
interview them, and the appointments are usually given immediately after discovery.
If the clinic moves away, follow up will become even more difficult.
The other main point with regard to notifications concerns the criteria of diagnosis
of tuberculosis. It has seldom been my policy to notify all the smallest or minimal
cases of tuberculosis, though I search through the contacts. Some physicians, not
necessarily local, are willing to notify some strongly positive tuberculin skin reactors
with negative x-ray findings, and yet other general hospital physicians, not always
nearby, sometimes omit notification of quite severe bilateral positive cases. It has
always been difficult to obtain notification, and therefore knowledge of contacts, of
non-pulmonary tuberculous conditions, such as renal or gynaecological tuberculosis.
So even now the picture of tuberculous notification may be incomplete.
With regard to deaths from tuberculosis, I also find frequently that if tuberculous
patients die primarily from some other cause such as bronchitis or even pneumonia,
then pulmonary tuberculosis may not be mentioned on the death certificate, even
though it must have been, in my view, a major factor in the patient's decease.
There were 95 new cases of respiratory tuberculosis in 1968, 24 of which were
bacteriologically proved soon after diagnosis. There were also 6 non-respiratory
notifications making a total of 101 new tuberculosis cases in all. This comprised
45 men, 41 women and 15 children. These numbers do not include a fairly large
number of inward transfers of known tuberculosis cases from other clinic areas. I do
nine sessions at the clinic and my assistant has now had his three sessions increased
to four to help cope with the heavy case load. All patients attending are examined as
well as having chest x-ray and other necessary tests. This involves more work, but
is clinically rewarding. Some centres have huge attendance figures, but comparatively
few patients actually seen by the physician, so 5,672 attenders last year meant a great
deal of work. B.C.G. was given to 139 contacts or other adults found tuberculin
negative.
The health visitors carried out 1,943 home visits, 1,315 successful and 628 unsuccessful.
The clinic had knowledge of 32 new cases of lung cancer during 1968, of
which 26 were diagnosed here. Many cases of chest infections were dealt with through
the year, and chronic bronchitis, emphysema and bronchial asthma remain some of
the main problems.
Heavy smoking of cigarettes is a notable feature of Deptford life and exacerbates
many chest affections.
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