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In all oases on "Domiciliary Treatment," the panel doctor is asked
to furnish periodical reports on the patients' progress and the need for
continued or altered treatment. In addition, these patients are
examined periodically by the Tuberculosis Officer. On December 31st,
1925, 250 patients were receiving " Domiciliary Treatment."
(v.) The arrangements for following up patients in cases where the
diagnosis is doubtful.
Arrangements for following up cases in which the diagnosis is doubtful
vary according to circumstances. Generally speaking, an effort is
made by means of frequent physical and sputum examinations, to come
to an early decision, but this is not always possible, especially with
children. If this method is not successtul and the case is an urgent one.
a recommendation to the London County Council for admission to
hospital for observation for diagnosis is made, or the case, especially if
surgical tuberculosis is suspected, is referred as an out-patient to the
London Hospital for a further opinion. In cases where there is no
urgency and where the lack of a definite diagnosis does not imply a
corresponding lack of proper treatment, the patient is discharged from
further attendance but is kept under general observation in conjunction
with his own doctor, if he has one. He is advised to return for further
examination after a suitable lapse of time—3 or 6 months—when, if
he does not come, it is generally found possible to get him to do so
by means of a letter or visit. Cases of this kind among school children
are referred, as described above, to the Divisional School Medical Officer
to be kept under observation by the School Medical Officers, generally
for a period of six months, after which they are returned to the
Tuberculosis Officer unless circumstances render an earlier return advisable.
(vi.) The arrangements for securing the examination and systematic
supervision of " home contacts
Contacts are examined at the Dispensary as soon as possible after a
case is notified. Arrangements for their attendance are made by the
Health Visitor when visiting the home or by letter, and the convenience
of the patients themselves is studied as far as possible with regard to
the time of attendance. Child contacts of school age, whether already
examined by the Tuberculosis Officer and found to be apparently healthy,
or unexamined, are passed on to the Divisional School Medical Officer
for observation, to be reported on in due course. 441 contacts were