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patient has been trained to take the necessary precautions; for at no
stage of the disease need the educated consumptive be a danger to
anyone. Therefore, in the absence of any provision to isolate or even
to adequately supervise the advanced cases which are notified to me,
the process of infection doubtless continues to go on in dozens of
homes in Stoke Newington. and this will remain so until more com
prehensive measures are adopted.
At present the preventive measures practised in the Borough are
insufficient—more especially in regard to the detection of early cases
and the isolation and supervision of the dangerous advanced cases.
The measures that we have been able to adopt up to the present are
the following: The cases notified to us are almost without exception
in an advanced stage of the disease, and it is comparatively rare that
one gets to hear of a case which is suitable for admission to a sanatorium.
An inspection of the dwelling of the person notified is made
and an inquiry is instituted as to the famih and personal histon
and present occupational and home circumstances of the patient. I
personally visit all cases and give verbal instructions and suggestions,
but at the same time a printed handbill of advice is given to some
member of the family. In necessitous cases the Borough Council
supplies a disinfectant gratuitously, and the premises are disinfected,
occasionally during their occupancy by the patient but always on
removal or death. Assisted by the official woman health visitor and
occasionally by voluntary health visitors, it has been possible to keep
some of the worst cases under a limited degree of observation ; but it
has not been possible to undertake systematic visitation and observation
of the patients, nor the clinical examination of all those who have
been in close contact with the sufferer.
Thus the notification of Consumption has impressed upon all those
who have thereby been brought in contract with many cases of this
disease among the poorer people, one outstanding circumstance
demanding remedial measures, viz., that a large proportion of those
notified are suffering from the disease in too advanced a stage for
sanatorium or other treatment to afford much prospect of success