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There is a highly organised system for dealing with cases of tuberculosis. Each case, as notified,
is personally visited by the medical officer of health, Dr. Kenwood ; he has so visited every case
notified since notification came into force. Acting in co-operation with the medical attendant, and
with his consent, he visits the home and leaves a copy of a leaflet of general instructions,and files in his
office a record of the patient's circumstances.
The medical visit is followed up by a series of visits either by the female sanitary inspector, who
reports on the condition of the premises, or by one of the voluntary health workers, or by visits of both.
The voluntary health workers number eight, each having a separate district; they meet regularly and
report to the medical officer of health then and at other times. In this way constant observation
is kept on the homes and families of comsumptive patients. Certain cases also obtain individual assisttance
and material relief, owing to their being reported to the Invalid Children's Care Association or
to the Charity Organisation Society.
The medical officer of health visits certain cases repeatedly and has noted some secondary cases
among contacts, but he is unable to make a systematic medical examination of contacts. Such
cases as receive sanatorium treatment do so through charitable agencies ; the Borough Council retains
no sanatorium beds. Dr. Kenwood, who has given much attention to the subject, considers that
tuberculosis, if individual cases are to be effectively dealt with, must be approached by voluntary effort,
acting in co-operation with the sanitary authority. Disinfection is carried out after death or removal
of the patient and at other times as occasion requires ; there is also supplied to each house as much
disinfectant for room or personal use as the patient requires. The Council undertakes to have specimens
oi sputum bacteriologically examined for medical practitioners free of charge ; it does not provide
sputum flasks for patients.
Borough op Wandsworth.
The deaths in the year 1908 from phthisis were 282. The population was estimated as 289,500.
Voluntary notification has been in force since the year 1903, with the following results :—
Year. Cases notified. Deaths from phthisis.
1902 — 221
1903 88 237
1904 118 288
1905 104 271
1906 74 274
1907 49 268
1908 85 282
Upon receipt of a notification a visit is paid to the house by one of the female sanitary inspectors ;
the premises are inspected and reported on and any defects remedied : disinfection is carried out when
necessary; a spit bottle is given to the patient; a card of instructions is left with the patient or friends;
a number of details regarding the personal condition of the patient are noted and advice is given about
regimen ; inquiries are made about the health of persons in contact with the patient and in certain
cases the female sanitary inspector advises the calling in of a doctor to see some member of the family who
may be ailing. As long as the premises contain a case of the disease they are kept under observation
by the female sanitary inspector, who visits once a quarter or oftener ; at death or removal disinfection
is offered, and if the patient moves to a known address his name is notified to the medical officer of health
of the district. Dr. Caldwell Smith, the medical officer of health, finds it impossible personally to
visit the cases, but considers that a medical examination of contacts would be very useful for
disclosing early cases.
The Borough Council has no control over or disposal of any sanatorium beds, and, generally
speaking, so far as individual patients are concerned, little assistance can at present be given to them by
that authority. It is not in special touch with voluntary aid societies. There is no local health society.
Facilities are provided by the Council for the bacteriological examination of sputum for medical practitioners,
free of charge.
City of Westminster.
In an estimated population of 170,545 there were 213 deaths during the year 1908 from phthisis.
Voluntary notification has been in force since the year 1903, and the cases so disclosed and the deaths
have been as follows:—
Year. Cases notified. Deaths from phthisis.
1902 — 328
1903 124 (9 months) 301
1904 148 268
1905 112 265
1906 78 241
1907 110 235
1908 155 213
On receipt of a notification a visit is paid to the patient's home by the assistant medical
officer of health, and inquiries made as to the patient's circumstances and the sanitary condition of