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49
but, as many of the patients keep under regular supervision at the dispensary, reports are not
asked for in these cases.
Cases doubtful, even after a period of observation at the dispensary, are, if it
seems advisable, referred to the Loudon County Council for observation in hospital. During
1924, 8 cases were referred for observation, and 5 found to be tubercular.
Under the heading “Consultations” are classed only consultations with the doctor at
the home of the patient. As almost all the doubtful cases are fit to get about, they are
generally referred by the doctor to the dispensary. This accounts for the small number
of entries here.
Visits by Tuberculosis Officer to homes of patients are 90 over those in 1923.
Sputum examinations are 163 over those for 1923.
Nurses' visits are 142 more than in 1923.
There is a large amount of dispensary work not included in this return. A copy of
all the notifications in this area is sent each week to the Tuberculosis Officer. These
notifications may be those of cases under practitioners or attending hospital out-patient
departments, or may be notifications of cases under treatment in hospitals. The Health
Visitors from the Public Health Department visit at the homes to ascertain the circumstances,
report on sanitary conditions, give advice to patient and those in contact with him,
and take steps as regards disinfection and the prevention of infection in others. Inquiry is
made as to whether the patient is receiving the necessary treatment, or if the patient's
doctor wishes him to attend at the dispensary. Any doubt in this matter is dealt with by
writing the doctor and asking if he wishes to consult with the Tuberculosis Officer re the
form of treatment most suitable to the circumstances of the case. If the patient is in
hospital a report is asked for, and forwarded to the London County Council if the doctor in
charge of the case wishes to recommend the case for institutional treatment. From these
inquiries, if it is ascertained that patient's attendance is desired, he is instructed to attend.
No bar is placed on the attendance of any patient at the dispensary where tuberculosis is
suspected. Such cases come of their own accord, or may be referred by School Medical
Officers, Health Visitors, or social workers.
In the year 1924, 177 recommendations were made to the London County Council for
institutional treatment. These included second recommendations and patients of other
years. Progress reports are furnished yearly on cases which have had institutional treatment,
and 306 of these were furnished in 1924.
406 reports were made to the Ministry of Pensions on cases sent for opinion as to
diagnosis or treatment.
Re Co-operation with Prac/itinner.—A report is made on every case referred for
opinion, stating in full the patient's condition, if ho is recomimnded for institutional treatment,
and again a full report is made on his condition on discharge, when he goes back again
under his own doctor. 161 reports were made on insured cases, and 355 letters or other
reports about cases.
Co-operation with School Medical Service.—Cases referred for opinion by the School
Medical Officer are reported on. 211 school cards have been made out for school
contacts of notified cases, and a report made on the child's condition if it has been seen at
the dispensary. If not seen, the card is so marked and sent to the School Medical Officer, so that
these children can be specially observed at school. Every year the Divisional School Medical
Officer goes over these cases with the Tuberculosis Officer for further consideration. Reference
of cases is made to the School Care Committee or clinic for the treatment of teeth, eyes, ears,
nose and throat.