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35
frequently come across persons in bad health in families in which no
case has been notified, and if not already under medical supervision steps
are taken to have them examined. In this way 467 persons were
specially examined, and 24 were found to be suffering from pulmonary
tuberculosis and 9 from other forms, 73 have moved from Westminster
or died, 30 have been marked off and the remainder are still under
observation. These persons were examined:—
At hospitals, dispensaries, or by private doctors 275
At school medical inspections 48
At the Pimlico Infant Medical Inspection Centre 116
At the Soho Infant Medical Inspection Centre 28
In addition, 185 bacteriological examinations of sputum were made
at the Council's expense for medical men who had suspicious cases
under observation, and in 34 instances the bacillus was found. In some
instances medical men had this examination made by other than the
Council's Bacteriologist, and the hospitals have this done by their own
staff.
Dr. Newsholme, in his report for 1913 to the Local Government
Board, points out that the success of a scheme for dealing with tuberculosis
depends upon the accuracy of diagnosis. If the disease is not
recognised at an early stage, curative treatment is liable to fail and
direct measures for preventing the spread of infection can only be taken
from the date when the disease is recognised.
The decision as to whether a patient is actually tuberculous or not
is often difficult, there being no general agreement among physicians as
to the minimal physical signs and other evidence which may be
accepted as indicating the existence of tuberculosis. While some
regard certain conditions as warranting a diagnosis of tuberculosis,
although no tubercle bacilli have been found in the sputum, others go
to the other extreme and decline to pronounce a patient tuberculous
until the bacilli is demonstrable, fearing to cast a stigma on the patient.
It is well known that delay often implies unfortunate consequences for
the patient, and the probability of a cure being effected is very much
greater if the disease is diagnosed before tubercle bacilli commence to
be discharged in the sputum. The many borderland cases concerning
which no definite diagnosis can be made require to be kept under
regular supervision.
It is, at present often the case that a proportion of the cases when
notified are suffering from more or less advanced disease. This is due
to two causes—generally to the patient's delay in obtaining medical
advice, but in a number of cases to medical delay in recognising the
disease. Recourse to examination of the sputum in such cases would
probably have insured earlier and more satisfactory treatment. Too