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the incidence of tuberculosis in the City. It might he well to enumerate
the various spheres in which such action would operate:—
(1) The immediate treatment of acute or emergency cases.
(2) The prolonged treatment of uninsured patients who are unable
to meet the expense of private medical attendance, many of
those are in a category midway between acute and advanced
or bedridden cases. They have usually had a period of
Sanatorium treatment, but have been discharged without
regaining working capacity.
(3) The advanced, bedridden and infectious cases.
"It is extremely important to isolate cases of this sort in institutions.
By so doing a great deal of infection can be prevented. Much has already
been done by the Guardians in this respect, but a much larger degree of
isolation is possible. Of the total deaths from tuberculosis in Westminster
in 1922, 65 per cent, died in hospitals or in the Infirmary. This is probably
a higher proportion than is generally found in London. There is no doubt
that the last six months in the life of a consumptive is the period in which
he is at least likely to take precautions against spreading infection. If
this period can be spent in an institution, the risk of massive doses of
infection to members of his household is very considerably diminished."
"There is still, unfortunately, a very larg' proportion of cases of tuberculosis
where the diagnosis is made too late for treatment to be of any
avail. The Medical Officer of Health has already dealt with this in the
section of his report devoted to the Notification of Tuberculosis. The
fault largely lies with patients, who postpone seeking medical advice until
their symptoms are sufficiently severe to prevent their working. By
this time the disease is well advanced and the outlook is hopeless. Much
less frequently does the fault lie with the medical practitioner attending.
The standard of medical practice in Westminster is high, although exceptionally
there may be failure in diagnosis and consequently in notification.
The matter of early diagnosis is particularly urgent in young women
between the ages of 15 and 25 years. In them the disease frequently
shows characteristics of acute and rapidly progressive tendencies, and it
is possible that some lives might be saved if the Council's provisions were
again brought to the notice of medical practitioners."
"327 cases of tuberculosis were recorded by the Medical Officer of
Health in 1922. The Dispensary dealt directly with 148, or 45 per cent, of
this gross total. For practical purposes one must deduct cases occurring
in asylums, 18 in number; 46 who died within 5 days of notification, and
some 40 cases occurring in common lodging houses where no information
concerning their previous state of health was obtainable until they
entered the Infirmary. The percentage thus calculated as cases dealt
with through the Dispensary works out at 69. When one considers that