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entirely with the county or county borough council as local health authority, deriving its powers from
section 28 of the National Health Service Act (Prevention of illness, care and after care). This impression
is incorrect, for certain and definite duties rest on local authorities and medical officers of health in accordance
with the Public Health (Tuberculosis) Regulations of 1930. These duties may be summarised as follows :
The Medical Officer of Health of a local authority must keep a register of persons suffering from
tuberculosis who are resident in the area for which he is responsible, and must pass relevant information to
the County Medical Officer of Health and to the Medical Officers of Health of other local authorities. On
receipt of a notification he must make " such enquiries and take such steps as are necessary or desirable for
investigating the source of infection, for preventing the spread of infection, and for removing conditions
favourable to infection
The local authority may, on the advice of their Medical Officer of Health "supply all such medical
or other assistance, and all such facilities and articles as may reasonably be required for the detection of
tuberculosis, for preventing the spread of infection and for removing conditions favourable to infection, and
for that purpose may appoint such officers, do such acts and make such arrangements as may be necessary ".
The local authority may also provide and publish or distribute information concerning tuberculosis
and precautions to be taken against the spread of infection.
These requirements of the Public Health (Tuberculosis) Regulations give Metropolitan Boroughs and
District Councils considerable opportunity for controlling and preventing tuberculosis. It must be remembered
that this disease is associated largely with two factors :
(1) The provision of an adequate and satisfactory supply of food ; and
(2) The environment under which a population is living.
National policy is determining the question of food. Improvement of environmental conditions rests largely
with the Metropolitan Boroughs and District Councils.
Procedure.
Following upon the receipt of notification, information is passed to Dr. G. A. Back, Tuberculosis
Officer and Chest Physician in the Borough of St. Pancras. As soon as a visit has been made by the
Tuberculosis Health Visitor the Public Health Department is informed in order that the environmental
conditions may be investigated by the District Sanitary Inspector. It has been found advisable that the
first approach to the patient should be made by the Tuberculosis Health Visitor for it sometimes happens that
the patient is not aware that a diagnosis of tuberculosis has been made in his case. By the time of the visit
of the Sanitary Inspector, the patient is aware of the diagnosis, has some general idea of the steps which must
be taken to secure adequate treatment, and is prepared to discuss environmental factors with the
Inspector.
Object of Visit.
The investigations of the Inspector are aimed primarily at the prevention of the spread of infection
and towards removal of conditions favourable to infection. This entails inspection with relation, principally,
to overcrowding, general hygiene, including lighting and ventilation, and sanitation. In consultation with
the Tuberculosis Officer, recommendations are made for re-housing and are forwarded to the relevant housing
authorities, calling attention to the particular priority needed in each case.
Sanitary defects, and where possible the lack of certain amenities, such as separate water supply and
food storage accommodation, are dealt with by the service of notice upon owners under the Public Health
(London) Act, 1936, or the Housing Act, 1936. The table at the end of this report summarises some of the
conditions that were found.
The Survey.
We investigated 242 cases. An investigation of certain premises was not made because the conditions
were already known, the case was first notified on death, or for other specific reasons.
There are in the Borough of St. Pancras two hostels for the working classes. One contains residential
accommodation for 1,087 and the other for 958 men. In these two hostels were notified during the year,
36 cases of persons suffering from Pulmonary Tuberculosis. All these 36 persons were not resident in the
hostels throughout the year. Three were admitted to hospital shortly after we received the notification
and others have left and moved elsewhere. There are, of course, other persons notified as tuberculous in
these hostels who were notified during earlier years, and at the end of 1949 the number of tuberculous persons
resident in the two hostels was 59. These premises accommodate only males, and it is a fact that many of
the cases are elderly persons with no relatives, limited means and suffering from open tuberculosis. They
tend to wander from district to district, between the hostel and the hospital. On the other hand the hostels
are under supervision, provide dining and recreation rooms, meals at a reasonable price, and each patient
has a separate cubicle bedroom. Whilst the conditions are not ideal fcr a person suffering from tuberculosis,
neither from his own point of view nor that of those with whom he is resident, the patient is at least segregated
from children and young persons, and to that extent better placed than if he were in a private dwelling
sharing his accommodation with a family of young children.
In 19 cases of pulmonary tuberculosis the premises were statutorily overcrowded. At first sight this
may seem a small number. It must be remembered, however, that the standard of statutory overcrowding