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58
City and beyond the reach of many persons; both require 'letters' to
continue treatment; and the demands on Brompton are already far in
excess of its accommodation. But in addition to insufficient facilities
for obtaining the medical examination of 'suspects,' there would seem
to be other difficulties in the way. Where the suspected case is in
apparently fair health, the patient—or in the case of a child, the
parent—is unwilling to afford the time for the journey and lengthy
attendances at a hospital. And if the time spent means the loss of
a day's work, the visitor hesitates to weaken her authority by urging
what may prove to be a tiresome and unnecessary visit. Thus the
patient remains without treatment until very definite symptoms declare
themselves. The work of the visitor loses in this way and in others by
the absence in the home of the medical man. She has, and can have,
little real authority without medical advice and support. Again, on
other points the existing system would seem to be at fault. Medical
treatment is irregular and discontinuous. Patients move quickly from
one medical agency to another—in one case seven different medical
agencies were attended within a few years ! This is no doubt often due
to the patient's anxiety to find a speedy' cure,' and sometimes to rapid
changes of address as the patient, if a wage-earner, descends into
cheaper quarters; but it is also to some extent encouraged by the
existing hospital system. An out-patient becomes too ill to continue
his attendance at a hospital. Failing admission as an in-patient, he is
obliged either to forego medical treatment, or to have recourse to
a private doctor, the Poor Law doctor, or to some general dispensary
from which bedridden patients are visited in their own homes by the
physician. On recovery—or partial recovery—from his acute attack, he
will again, in all probability, seek a chest hospital, or a great general
hospital, where he believes he is more likely to receive specialist
treatment; or he may do without any medical assistance until weakness
or another acute attack supervenes. He may, or may not, return to the
hospital he previously attended, but in any case the continuity of
treatment is broken."
Bacteriological Examination of Sputum.—Sixty examinations were
made of sputum, one of pleural effusia, to ascertain if the tubercle
bacillus was present. It was found in 22 instances.
Disinfection.—Two hundred and fifty-three rooms in 190 houses and
2,069 articles were disinfected by the Council's staff, 35 articles were
destroyed, and general cleansing of the premises was carried out after
each death, or on removal from one house to another, entailing 385
visits.
Deaths.—The deaths for the last nine years are set forth in the
following table:—