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the house. These are noted and filed for reference. Printed suggestions are left as to general hygiene,
and inquiry is made as to the health of other members of the family and friends, but no systematic examination
of contacts is undertaken by this officer. The case is then sent on to the Westminster
Health Society for regular visiting and for such arrangements to be made for the patient's welfare as
may be found desirable or possible. Dr. Francis Allan, the medical officer of health, considers that
the examination of contacts or suspected secondary cases requires special arrangements, owing to the
fact that if a contact who may be ailing is referred to a medical practitioner or to a hospital, without
special attention being drawn to the case, early signs of disease may easily be overlooked. The
question of sanatorium beds being retained by the Westminster City Council is under consideration.
At present the Health Society is the means by which patients are enabled to reach sanatoria; and
the Society works in co-operation with the Jewish Health Board, the St. Anne's Fund Trustees,
the Invalid Children's Aid Association and the Charity Organisation Society. Arrangements are made
by the City Council to have specimens of sputum examined for medical practitioners free of charge.
Sputum flasks are distributed by the Health Society.
Borough of Woolwich.
In an estimated population of 131,346 during the year 1908, there were 160 deaths from phthisis.
Voluntary notification has been in force since the year 1902, the cases notified and the number of deaths
in each year being as follow :—
Year. Cases notified. Deaths from, phthisis.
1902 189 181
1903 167 176
1904 186 205
1905 145 190
1906 176 169
1907 150 161
1908 154 160
Dr. Sidney Davies, the medical officer of health, endeavours to see every notified case himself
when the patient lives at home, and with very few exceptions has succeeded in doing so up to the
present; he is not able, however, to pay a succession of personal visits to keep the patient under observation,
and he does not consider that such detailed attention is compatible with the general supervision
of his department which is required from a Borough medical officer of health. The cases in the
Borough, however, are kept under observation by the sanitary staff, although the female sanitary inspectors
are precluded by pressure of other work from attending to this, and the want of additional
staff is much felt.
At the notification of a case, a card of instructions for the avoidance and prevention of
consumption is handed to the patient, and general inquiries are made about the health of the other
members of the family. A sanitary inspection is also made, and any defects are remedied. Disinfection
is carried out when necessary and was performed at 157 premises during the year 1908. Individual
attention is paid to the patient; he is provided with a spit cup at cost price, and his sputum is examined
at the Lister Institute on behalf of the Borough Council. Application on his behalf for admission to a
sanatorium is entertained from the medical practitioner in attendance. Seven beds in the
Maitland Cottage Sanatorium, Peppard, Oxfordshire, are maintained by the Council, and patients
are sent there on the recommendation of the medical officer of health, who decides as to the
suitability of the applicant. Applicants are required to show that they are not in a position to
pay the fees required at a self-supporting sanatorium. All the seven beds were occupied throughout
the year 1908, and there was generally an excess of demand for them over supply. Three of the
beds are intended for one month's rest and treatment, and to have an effect which admittedly
may be no more than educational, so that on returning home a similar style of life may be
kept up.
The Borough Council works in association with a charitable fund which assists in prolonging
the stay of certain patients considered suitable for such aid. A record has been kept of the results
of the cases dealt with, and although in many cases arrest of the disease has not followed sanatorium
treatment, the general results have been encouraging. Dr. Davies states that even those patients who
are too far advanced in consumption to benefit very materially have their lives lengthened and learn
how to continue the treatment at home and to avoid being dangerous to their neighbours. Of the 70
applicants entered on the register for admission to the sanatorium in the year 1908, 40 were admitted ;
11 were too far advanced for admission ; 3 were found to be not tuberculous, and 1 could not afford to
give up work. Others were admitted to convalescent homes, consumption hospitals, other sanatoria, or
the infirmary; but all received instructions as to the means to be taken to promote their own health
and to avoid infecting other people. Dr. Davies is of opinion that much additional good work could
be done by definite medical examination of contacts, so that early cases might be picked out, and by
keeping patients at home under observation by a special inspecting officer of the public health
department.