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41
can be excluded. Some seven injections of tuberculin were given for
diagnostic purposes, two proved positive, five negative. The two positive
cases were indefinite as regards physical signs and X-ray, but had slight
temperature and complained only of general malaise: five Von Pirquet
reactions were performed on children under the age of five, who had indefinite
signs and symptoms. Two were positive.
The Council provides for the examination of specimens of sputum.
The examinations are made by the City bacteriologist at his laboratory.
In every new dispensary case having expectoration an examination is
made. In a certain number of old cases re-examinations are made where
previous results proved negative. No restriction is placed on the number
of specimens sent for examination. Negative sputum results are
not held to preclude a diagnosis of tuberculosis in cases presenting other
features of significance; 239 specimens were examined for the dispensary
in 1920. In 31 tubercle bacilli were found. In 4 cases where the
sputum proved negative on repeated examination of samples submitted
by the patient to the City bacteriologist, positive results were obtained
in hospital to which the patients were sent for observation.
Treatment.—Reference has already been made to hospital and sanatorium
accommodation for the purposes of observation and treatment.
This department is entirely under the administration of the Insurance
Committee for the insured and of the London County Council for the
uninsured. It ought to be mentioned that there is a distinct lack of
accommodation for "hospital" or advanced cases in women and in men
who have not served in the fighting forces in the late war.
Domiciliary treatment for all insured consumptives is carried out by
the practitioners in the district. The experience of five years leads one
to believe that this form of general and symptomatic treatment has been
carried out efficiently and satisfactorily. It is interesting to record that
21 ex-service men who were discharged from various institutions more
than two years ago as unlikely to derive benefit from further sanatorium
treatment have made steady improvement under domiciliary treatment.
In four instances bacilli can no longer be found in the sputum. All
are Turban Gerhardt III cases with marked anatomical, changes in the
lungs and are still regarded as unfit for work which entitles them to full
treatment allowances and extra food. During the two years since discharge
from sanatorium they have been entirely free from financial
anxieties, their dependents being provided for. Their diet has been
ample and nourishing and they, have been leading lives of ease. Their
fortunate state must surely be the outcome of such a happy triad, ease
of mind and of body and unrestricted diet. They now have no symptoms