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69
to read a paper before the Hackney Medical Society at its monthly
meeting. I gladly accepted, and was most kindly welcomed by the
members.
I have in previous reports called attention to the desirability
of examining contacts, especially those living in heavily infected
houses. It is in many cases difficult to persuade them to come, but
the health visitors have again been successful in this direction, and
a notable and satisfactory feature has been the high proportion
(60.18%) of adults attending.
The residential treatment of tuberculosis is at present the chief
means of securing cure of the individual patient, and of preventing
spread of the disease by the segregation of infectious persons.
All such treatment is now provided by the London County
Council, and as far as pulmonary cases are concerned, there
are three main types of institution: (a). The Sanatorium,
for early cases; (b). The Special Hospital, for intermediate
cases, and (c). the local General Hospital—for more advanced
cases, or for those in which some sudden emergency has
arisen which necessitates skilled nursing and constant medical
supervision. The accommodation in the first two classes is
always fully taxed, but during the past year the County
Council authorities have made every endeavour to give an opportunity
for admission to the new patients recommended from the Dispensary.
Such treatment has a special value as, apart from the surprising
progress made by some persons with extensive disease when
they came under sanatorium regime, the lessons learned by them
in the sanatorium or hospital concerning the measures to be taken
in their own interests, and those of their families and associates,
are most beneficial. In November and December, when the number
of new cases attending was exceptionally large, a regrettably
high proportion were in a rather advanced stage, but practically
all of them were offered residential treatment.
For the advanced case who has been away before, there is as a
rule, only the local General Hospital, and the old prejudice against
entering such an institution still persists. A few patients have been
admitted to St. Joseph's Hospice, and this Hospice without doubt
carries on a most useful and humanitarian work in the locality.