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disinfection is also usually effected. Occasional visits are paid thereafter by the sanitary staff, bat it
is found to be difficult, without special staff for the purpose, to keep the various cases under observation,
partly owing to the efforts at concealment which tuberculous patients are apt to make. The
services of a health visitor are felt to be required for this work. The Borough Council does not
retain any sanatorium beds, nor does it hand on tuberculous cases to any charitable society in
co-operation with itself. There is no examination of contacts to ascertain the presence of secondary
cases. Bacteriological examination of sputum is arranged, free of charge, for medical practitioners
who desire it. Sputum flasks for patients are not distributed by the Council.
Royal, Borough of Kensington.
There were 182 deaths from phthisis during the year 1908, the estimated population being 182,752.
Voluntary notification has been in force since the year 1902, and the following figures
show the number of cases notified since that year, the deaths being added for comparison.
Year.
Cases notified.
Deaths from phthisis.
1902
247
232
1903
221
223
1904
203
257
1905
218
204
1906
252
229
1907
231
187
1908
229
182
On receipt of a notification a visit is paid by one of the women sanitary inspectors, a sanitary
inspection is made, and an inquiry into the personal circumstances of the patient. Advice is given
as to the regimen of the patient, and a second visit is always paid to see that the advice is being
intelligently followed. In some cases, especially in those which have to be followed up for being
sent into sanatoria, repeated visits are paid. During the year 1908, for instance, 342 cases were
investigated and 868 visits were paid.
Disinfection after death or removal is always offered and usually carried out. No systematic
medical inspection of contacts is made, and Dr. Sandilands, the medical officer of health, is
unable, from pressure of other work, to visit cases personally. The sanitary inspectors emphasise
the late stage at which patients come under observation. "In a large majority of cases," they
say in their 1908 report, "the disease was in an advanced stage when notified, the sufferers having
continued to work for the support of their families, and rarely having seen a doctor till absolutely
compelled."
The Borough Council does not retain sanatorium beds, but is in close touch with the district
committee of the Charity Organisation Society. There is a Health Society in the Borough, but it does
not deal with this class of case. Bacteriological diagnosis of sputum for medical practitioners is
arranged for at the Lister Institute by the Borough Council free of charge. Sputum bottles are
provided for patients.
Borough of Lambeth.
During the year 1908 there were 472 deaths from phthisis in an estimated population of 321,344.
Voluntary notification has been in force since the year 1902, the figures and the deaths
from that disease showing as follow:—
Year.
Cases notified.
Deaths from phthisis.
1902
315 (7 months)
526
1903
339
430
1904
306
448
1905
293
431
1906
332
430
1907
322
487
1908
373
472
Notification is accepted of those cases only which are confirmed by the presence of tubercle
bacilli in the sputum. The Borough undertakes to have bacteriological examinations made, free of
charge, and 183 such examinations were made in the year 1908. Sputum flasks are not provided for
patients.
On receipt of a notification of a case of phthisis (with tuberculous expectoration) a circular
letter is sent to the home of the patient offering disinfection; this process is also carried out on
the death or removal of the patient. Disinfection in a case of phthisis is treated in as thorough
and serious a manner as if the case were one of small pox.
Every fortnight a sanitary inspector calls with a supply of personal disinfectant for the patient,
but he is instructed to ask no questions. He takes the first opportunity of leaving a leaflet descriptive
of general and special preventive measures which ought to be taken. No visits are paid to the patients
by the women sanitary inspectors or by the health visitor; the contacts are not examined for secondary
cases. Dr. Priestley, the medical officer of health, is precluded by pressure of other wort from
personally visiting cases of phthisis. The Borough Council rents no beds at sanatoria, and is not
specially in touch with charitable societies to which tuberculous patients may be handed over.
1814 c