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236
1912]
Family History .— Father living. Mother dead—" tumours and wasting." Three sisters living
and healthy. One sister dead—" operation." Two brothers living and healthy. One brother dead
—"accident." No history of chest trouble in family. Wife, old scar of tubercular abscess. No
evidence of active tubercular disease. Daughter, no evidence of active tubercular disease.
Household arrangements.—Patient sleeps with wife. Child to be removed to other room.
Window open day and night. Premises passed by Sanitary Inspector as satisfactory.
Patient was placed under regular treatment on September 12th, tuberculin injections being
001 c.c. (first curative injection) general medical treatment. The treatment has been continued
since patient was recommended for sanatorium benefit, and is showing good results.
Although tubercle bacilli have now, for the first time, been demonstrated in sputum in small
numbers, patient has had no undue reaction to injections, and is now (October 26th) receiving
.05 c.c.
I would, therefore, recommend that the present treatment be continued until the patient has
received a final curative and immunizing dose of 1 c.c. Koch's 0 1 Tuberculin.
The result of this report was that the expert adviser to the Committee
recommended that the treatment be continued, and, so far as the Medical
Officer of Health is aware, was still in process at the date of the termination
of these duties by the Public Health Department, February, 1913.
From this brief summary of the procedure adopted in the case of patients
recommended for domiciliary treatment, it will be seen that considerable
work devolved on the department, and in support of this statement it tnay be
mentioned that it became necessary to write no less than 484 letters, to reply
to numerous inquiries per telephone, to make copies of reports, and to write
up case-records and diaries; most of which it was necessary to have done
during the ordinary office hours. It was also necessary to visit patients late
in the evening to ascertain their wishes as to the doctor they desired to attend
them and as to the course of treatment recommended by their doctors, as they
were away from home at business during the daytime, and could not be seen
at any other time. Visits to medical practitioners also had to be made in
some cases to ensure their immediate attendance on certain patients; and in
at least three cases a message was received late in the afternoon from the
Insurance Committee for London requesting that arrangements should be
made for medical attention to be given to patients the same evening.
The work, taken in its entirety, was carried out smoothly and without
friction, although in several cases the patients openly expressed their disappointment
at the recommendation of the medical adviser of the Insurance
Committee for domiciliary treatment, when they expected to be sent to a