London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
London County Council 1919
[Report of the Medical Officer of Health for London County Council]
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The following table indicates the posit on in respect of the finding of tubercle bacilli in the sputum in the cases of the 163 children whose medical history is known up to 31st December, 1919 :—
Table III.
| No. of cases. | Known to be alive 31.12.19. | Known to be dead 31.12.19. | |
|---|---|---|---|
| Tubercle bacilli found in the sputum | 8 | 5 (62.5 per cent.) | 3 (37.5 per cent.) |
| Tubercle bacilli not found in the sputum | 11 | 11 (100 per cent.) | _ |
| No examination of sputum or no record of such | 144 | 122 (84.7 per cent.) | 22 (15.3 per cent.) |
It will be observed that there is a large proportion of cases in which no examination was made
or no record kept. This is probably due to the well.known fact that it is extremely difficult to obtain
sputum from young children.
Non.pulmonary.—The 53 non.pulmonary cases who completed one period of treatment before
31st December, 1915, have been classified as to location of disease :—
Table IV.
| No. of cases treated. | |
|---|---|
| Hip | 18=(33.95 per cent.) |
| Spine | 2=( 3.77 per cent.) |
| Other bones | 8=(15.10 per cent.) |
| Glands (including peritoneum) | 25=(47.18 per cent.) |
Of these, 2 refused medical supervision, 10 removed from the Council s area and could not be
traced, and in 5 cases the diagnosis of tuberculosis was not confirmed.
The subsequent medical history of the remaining 30 cases is shown in the following table:—
Table V.
| No. of cases treated and traced | Known to be alive | Known to be dead | |
|---|---|---|---|
| 31.12.19. | 31.12.19. | 31.12.19. | |
| Hip | 16 | 12 (75.0 per cent.) | 4 (25.0 per cent.) |
| Spine | 2 | 1 (50.0 per cent.) | 1 (50.0 per cent.) |
| Other bones | 4 | 3 (75.0 per cent.) | 1 (25.0 per cent.) |
| Glands | 14 | 12 (85.7 per cent.) | 2(14.3 per cent.) |
In one case diphtheria was the cause of death, so that the mortality from tuberculosis was 7 in 36.
or 19.4 per cent.
In his report to the London Insurance Committee Dr. Bardswell points out that
in the majority of cases the treatment given "failed in its chief object—viz., to cure
or sensibly to prolong life," and that "benefit of a permanent character was obtained
only in the relatively small group made up for the most part of those cases in which
tubercle bacilli were not found in the sputum." He then goes on to point out that many authorities
urge a considerable increase in sanatorium accommodation in order to enable a suitable case to
remain under strict treatment for a longer period than is now possible, and points out that this
consideration has also led to the proposal for the establishment of colonies or settlements which should
provide for indefinitely prolonged residence and treatment. After indicating some of the outstanding
features of such settlements, e.g., Papworth, Dr. Bardswell points out that although it is not
practicable at the present time to establish a " settlement" as part of a comprehensive scheme
for London, yet experiments on these lines might be encouraged by sending suitable London patients
to existing institutions of this character. With all these observations I entirely agree.
Additional institutiona/ accommodation required.—The great difficulties encountered in endeavouring
to arrive at an estimate of the future additional accommodation required for institutional treatment
have already been referred to in more than one portion of this report. They are only emphasised
here once more in order to make clear the fact that the figures now submitted must be regarded as
provisional. With this understanding then it is suggested that the immediate requirements can best
be dealt with by first and foremost a careful re.grading of the existing beds which have been acquired
for insured and uninsured patients; secondly, by the provision by the Council of the following beds,
to be distributed in accordance with the carefully considered needs of the patients, whether insured or
uninsured.
Existing Accommodation and Estimate of Additional Accommodation required.
| Classification of stage of disease | Adults Insured and Uninsured. | Children under 16 years of age. |
|---|---|---|
| Early | 600 | |
| Moderately advanced | 600 | |
| Advanced | 500 | |
| Surgical | 200 | |
| Observation and emergency | 200 | 650 for all classes of patients |
| Total | 2,100 | 650 |
| 2,750 | ||