View report page

8
free ventilation and light. That is then the first point—to minimise infection proceeding from an
ascertained case. The next is to endeavour to ameliorate his condition and circumstances; and
lastly to fortify those in contact with him so as to prevent them falling victims either to infection
or to the conditions to which he has succumbed; this implies keeping the home and its inmates under
continuous medical observation.
In the Appendix to this Report will be found a detailed statement of measures in operation
in the respective districts of the County. They are here summarised and include the following:—
An inspection of the dwelling of the person notified and report thereon; an enquiry and report
as to the personal circumstances of the patient; the issue of printed general instructions as to the
prevention of the spread of the disease, and suggestions as to personal hygiene; occasional
or periodical disinfection according to the circumstances of the case, and disinfection of premises on
removal or death of patient. These measures are now (September, 1909) in effect in every district
in London. In the Boroughs of Bermondsey, Bethnal Green, Deptford, Greenwich, Fulham, Hackney,
Hammersmith, Holborn, Islington, Poplar, Shoreditch and Stepney, it is not found possible to repeat the
visit of inspection (unless at long intervals), or to keep patients under observation; administrative action
is limited to the measures mentioned above, except that in the Boroughs of Fulham and Bermondsey
the respective medical officers of health visit each patient at home once; in the Borough of
Greenwich the medical officer of health visits certain of the cases; and a few cases in the Borough of
Stepney are handed over to a voluntary health society. In the Borough of Lambeth patients' homes
are kept under observation by the fortnightly visit of a sanitary inspector for the purpose of leaving
a supply of disinfectants for the personal use of the patient; in the Boroughs of Camberwell, Southwark
and Woolwich patients are kept under observation as far as possible by periodical visits of a
male sanitary inspector. In the Boroughs of Battersea, Chelsea, Hampstead, Kensington, Lewisham, St.
Marylebone, St. Pancras, Paddington, Stoke Newington and Wandsworth, female sanitary staff visit
cases periodically and endeavour to keep patients and their homes under continuous observation.
In no part of London (except in the Borough of Woolwich (see page 23), does the sanitary authority
directly engage in the work of the personal amelioration of the patient, but in the Boroughs of
Battersea, Chelsea, Hampstead, Kensington, St. Marylebone, Paddington, St. Pancras, Southwark,
Stoke Newington, Woolwich and in the City of Westminster the respective medical officers of health
and female sanitary staff, or both, are in co-operation with voluntary health societies, which
undertake the personal amelioration of as many patients as possible. Owing to a variety of causes
affecting these societies, however, such as want of means, of staff or of organisation, there remain in
many districts a number of recognised cases whose sickness is unrelieved, or only partially relieved, in
addition to such other cases as are undisclosed.
No sanitary authority undertakes a systematic medical examination of contacts, to ascertain
whether any secondary cases arise among them. This measure is carried out by only one
body in London, viz., the Paddington Dispensary for Tuberculosis, a charitable institution which, as
mentioned below, was instituted at the beginning of this year. Brompton Hospital for Diseases
of the Chest examined 10 contact cases for London sanitary authorities during the eight months ending
July, 1909.
Sanatorium beds are directly retained by the Woolwich Borough Council, and are seven in
number; and these are kept constantly full by patients drafted to them on the recommendation of
the medical officer of health. By the City of Westminster and the Borough of Greenwich a similar
arrangement is under consideration. As regards institutional treatment of phthisical patients resident
in London, the evidence, generally speaking, goes to show that the demand for beds greatly exceeds
the supply.
From the foregoing summary it will have been seen that the action of sanitary authorities, in
dealing with pulmonary tuberculosis, is limited. Some of the methods usually adopted in the prevention
of the spread of infectious disease are not applied. It has not been found possible, for instance, to secure
the earliest news of all fresh and of suspicious cases, to keep them under constant observation till their
nature is clear, and to keep close observation on contacts, i.e., persons who [have been exposed to
infection, until risk of infection is past. No doubt certain infectious diseases are easier than others to
deal with in these respects, and pulmonary tuberculosis is not one of the simplest. The examination of
contacts, for example, may require repeated and extended examinations involving much time, and the
necessary period of observation may be prolonged for years. For this duty sanitary authorities are not
at present equipped with staff who can give to the work as much time as it requires. There is, moreover,
the personal amelioration of the patient. That may mean money help, more food, clothes, firing,
the personal encouragement of friends, and insistence on the patient and his friends helping themselves
—in a word, measures which are beyond the usual scope of sanitary authorities. In these considerations
may be found the reasons which have prevented them from taking more active official steps
against this disease.
Advantage has been taken of the present enquiry to visit certain organisations for dealing
with tuberculosis; and, by the courtesy of those in charge of them, a few notes are here given.
At St. Thomas's Hospital special efforts are made to treat cases of pulmonary tuberculosis effectively.
Each such out-patient, on his way from the physician's room to the hospital exit, is seen by the lady
almoner or one of her assistants. Registration is made of the name and address, and of certain
principal facts regarding the patient, special attention being paid to any points which have been
indicated by the examining physician. In one such case quoted, where tuberculosis was present in a
part of the body other than the lungs, an apparatus was prescribed as necessary, but the patient,
though earning some money, could not afford to pay for it. A visit to a convalescent home had also