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18
examination, therefore, so far from being neglected is regarded as tlie most
important work of the dispensary.
In 1917, 286 contacts were examined. Of these 206 were children
under 16 years of age and 18 of them showed signs of pulmonary tuberculosis
at the first examination.
In those 18 children the disease had not previously been discovered.
As pointed out in last year's report the disease is more insidious in onset
and more difficult of detection in childhood than in adults.
A recent memorandum from the L.C.C. has introduced the subject of
day sanatoria for children, suggesting that Borough Councils in London
should consider the establishment of such sanatoria in connection with
their municipal tuberculosis dispensaries. At the present time there
are five day sanatoria in London, viz., Camberwell, Bermondsey, Fulham,
Battersea, Hammersmith. With the exception of the last, all are run in
connection with the voluntary tuberculosis dispensaries of the Central
Fund for the Prevention of Tuberculosis.
These institutions have been in existence for over a year and may be
said to have now passed the stage of experiment. The dispensary medical
officers who are in charge of the respective day sanatoria are unanimous
in acclaiming the good results which have been obtained after a year's
trial. The children selected for treatment are those which have " passed
through " the dispensary. They are therefore in a sense all dispensary
patients. The L.C.C. as education authority supply the teacher and all
educational appliances. The necessary ground, shelters, wraps, rest
chairs, &c., are provided by the voluntary or municipal authority, who
also provide the midday meal. The cost of this works out at 3d. or 4d
per head and is recovered from the parents.
In concluding these remarks on contacts and tuberculous children
generally, I must add that I have been impressed with the fact that, of
those child contacts who present definite or suspicious signs of the disease,
the larger number live in basement dwellings. This is, of course, chiefly
evident in the Pimlico area.
It is encouraging to note that medical practitioners in Westminster
are showing still further confidence in the dispensary by sending up
patients for the opinion of the tuberculosis medical officer. In 1916,
80 were sent; in 1917, 148. In 1916, 25 consultations were held with
private doctors; and in 1917, 88. Many of those patients were seen
at their homes in consultation with the private doctor.
During 1917 there was a considerable increase in the work performed
for recruiting and national service medical boards. This is a sphere of work