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164
attendances of old cases at the dispensary is fewer and more time can be
devoted to the examination of new cases and to those who need special
advice and attention. The actual number of cases notified has slightly
increased and we are getting more systematic notification from hospitals.
The deaths also are slightly in excess, having been increased in number
by the complication of influenza and also by bronchitis and other lung
complaints induced by fogs which invaded London in December.
Schemes are in course of completion for the dental treatment of
tuberculous patients and also for X-ray examination of doubtful cases
where additional scientific evidence is required to complete the diagnosis.
The dental treatment is an important factor in treatment as the digestive
power of tubercular patients is always deficient, and decayed teeth are a
breeding ground for all microbes and channels of infection in tuberculosis.
The most recent extension of the work is the provision of extra
nourishment to suitable cases as an adjunct to their successful treatment
and recovery. Half of the cost of this will be undertaken by the Ministry
of Health up to a specified amount.
The bed and chair-bedsteads are in constant use and have proved
very useful in separating the infectious cases from the rest of the family
and are a great preventive factor. The use of shelters is very limited,
and though all are in occupation at present this system in Southwark
does not justify any great extension. A patient requires considerable
hardihood to occupy one under the conditions which exist in their back
premises. It is one thing to sleep in a shelter under the pine trees, but
quite a different proposition to sleep in one in a back yard or town
garden. The patients who have them are doing their best and trying to
put up with their conditions.
Excepting as a preventive measure in which it has a great measure
of utility, I cannot report that the patients have shown any marked
improvement from use of the shelters.
Copies of all notified cases are received from the Medical Officer of
Health, and on receipt of these a note is sent to the practitioner in charge
of each case, asking whether he wishes the Dispensary to take any steps
in regard to institutional or other treatment, and periodic reports are furnished
by them on the progress of domiciliary cases.
A very small number of actually tubercular cases have been found
among the contacts but many predisposed and delicate cases have been
found and dealt with by means of the Invalid Children's Aid Association,