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on the part of practitioners to make use of the forms of report devised in
Memorandum No. 286.
V.—The diagnosis of doubtful cases has always been regarded as one
of the chief functions of the dispensary, and if diagnosis cannot be
established at the first attendance, the patient is instructed to attend at
frequent and regular intervals—say bi-weekly, or once a week. Careful
records are kept, and examinations are made with a view to arriving
at a definite diagnosis as early as possible. Visits are paid to the
homes by the Health Visitors, who instruct patients in the use of the
clinical thermometer, and it is their duty to report to the Tuberculosis
Officer on the home conditions generally, and on any probable source
of infection there. If diagnosis has not been established within a
period of four weeks' regular observation, recourse is made to the
facilities provided by the London County Council in Brompton and other
chest hospitals. Certain figures relating to the disposal of doubtful
cases are included in Form R of the Ministry of Health, which is
appended.
VT.—The examination and supervision of contacts is the foundation
of the anti-tuberculosis effort of a dispensary. On visiting cases of tuberculosis
notified to the Medical Officer of Health, the Health Visitor
suggests examination, where practicable, of all home contacts. A
considerable proportion of adult cases notified in Westminster are single
individuals—domestic servants, persons living in hostels, clubs, etc.—
who are without home contacts in the family sense. Cases, however,
occurring in families are visited by the Tuberculosis Officer in their homes
after their first attendance at the dispensary. He is thus in a position
to visualise the surroundings, which is of great use in considering
the progress of the patient afterwards. The Health Visitor arranges for
the home contacts to be examined at this visit, or for their subsequent
attendance at the dispensary for this purpose. Negative results from
first or single examination of contacts are sometimes misleading and
may engender a sense of security which future events often fail to
justify in those who are constantly exposed to infection. Those who
live or work in close touch with an " open " case of tuberculosis should
be examined from time to time over a period of years. It would be
impossible for a single tuberculosis officer to keep under review all the
contacts of all notified cases in the City, but for school children the
need is met by the periodic school medical examinations. As regards the
insured classes, the attention of the insurance authorities might be directed
to considering the possibilities of routine examinations of insured lives,
with special reference to the effects which may be looked for in cases
where there is a family history of tuberculosis.