View report page

15
which, certainly on prima facie grounds does not appear to be justifiable. The following were among
the more important reasons which emerged :—
(1) Certain of the hospitals were stated not to have given the assistance which tuberculosis
officers felt they were entitled to expect by virtue of agreements whjch exist between the hospitals
and dispensaries.
(2) Some tuberculosis officers are evidently of the opinion that after having given careful
study to a doubtful case they are unlikely to obtain any further assistance by referring the
patient to the consulting centre provided in the agreement.
(3) In some cases it would appear that the tuberculosis officers do not refer patients to
the consulting centre because they fear that in so doing there may be some reflection upon
their capacity as clinicians.
(4) In other cases it is possible that there is a lack of appreciation on the part of the tuberculosis
officer of the benefits usually obtainable by consulting with more experienced men,
especially in the case of a disease so notoriously difficult of diagnosis in its earliest stages.
Various suggestions for an improved consulting service were made for the purpose of eliciting
criticism but it was abundantly clear that the majority of tuberculosis officers did not, from their point of
view, feel the need for a consulting service, although some of them favoured the suggestion of an occasional
consultation between a consultant of high professional standing and a number of tuberculosis officers
upon clinical material supplied by the latter. The chief value, however, which they seemed to attach to
such consultations was the interest arising out of an interchange of medical opinion.
Observation beds.—Practically every tuberculosis officer feels the want of observation beds (a)
to aid in diagnosis and (b) to determine the most suitable form of treatment to pursue. During the past
year some provision of beds for observation purposes has been made by the London County Council and
London Insurance Committee. Patients are sent at the request of the tuberculosis officer into beds
re e ved for this purpose but the tuberculosis officer complains that he has no right or access to the patient
and he never receives a report of the result of observation. This is not a correct statement of fact,
so far as the London County Council is concerned, but is obviously a prevalent impression which will be
removed at once.
Although many of the tuberculosis officers would like to have observation beds under their own
supervision in a local home they are practically all in favour of the provision of such beds at conveniently
situated general or special hospitals. All of them regard access to the patient and a right of consultation
with the physician in charge as highly desirable, if not essential.
Examination of contacts.—More or less stress is laid upon this work at all the dispensaries. The
general aim is to examine the contacts of all definite cases of tuberculosis, pulmonary and non.pulmonary,
dealt with by the dispensary, and such contacts of notified cases, not being dispensary cases, as are
referred by the medical officer of health or his staff. Contacts of " suspects " are sometimes examined
in order to assist in arriving at a diagnosis in the case of the " suspect." In actual practice the number
of contacts of non.dispensary cases which are examined is small but this depends to some extent on the
local arrangements for securing their attendance.
The following examples show this clearly. The Metropolitan Hospital serves Stoke Newington
and part of Hackney. The tuberculosis officer is dependent upon the exertions of the health visitors
for securing the attendance of contacts at the dispensary. During 1918, 153 contacts were examined
per 100 new cases of tuberculosis residing in Hackney and only 50 contacts per 100 new cases residing
in Stoke Newington. The difference appears to be entirely due to the difference in energy on the part
of the public health staff in the two boroughs. On a conservative estimate there are 700 contacts
of new cases of tuberculosis notified annually in the part of Hackney served by this dispensary and 320
in Stoke Newington ; 59 per cent, of the former and only 19 per cent, of the latter appear to have been
examined in 1918. The time of the tuberculosis officer of this dispensary is not fully occupied but the
arrangements for securing the attendance of contacts are not directly under the control of the tuberculosis
officer and are unsatisfactory.
In the case of North Kensington, during 10 months of 1919, 46 6 per cent, of the contacts of dispensary
cases have been examined but this represents only some 18 per cent, of the estimated number of
contacts arising in the area served by the dispensary. Contacts of dispensary patients may require to be
visited by the dispensary nurse several times to secure attendance and in some cases the tuberculosis
officer may visit the home and examine them there. In the case of the contacts of non.dispensary
patients the organisation of the dispensary cannot be put into operation to secure attendance as the
tuberculosis officer is not an officer of the sanitary authority, and cannot be informed of the names and
addresses of all persons notified under the Public Health (T. berculosis) Regulations.
In this respect municipal dispensaries are better situated than most voluntary dispensaries. In
Greenwich, for example, some 50 per cent, of the contacts of all notified cases appear to be examined in
normal times. In some of these dispensaries, however, shortage of staff or lack of appreciation of ti e
importance of the work seem to have resulted in only a small percentage actually being examined, e.g.,
10.20 per cent, in the case of Deptford.
The importance of this work needs to be strongly impressed on tuberculosis officers ; arrangements
should be made so that notifications may be transmitted to them in order to enable them to deal directly
with contacts and an adequate medical and nursing staff should be provided for this purpose. In some
cases the tuberculosis officer still prefers to examine contacts at their homes, but the majority of tuberculosis
officers find it more satisfactory and an economy in time to examine them as far as possible at
the dispensary.