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In the above figures concerning the gain in weight, only children who have been at the school
for more than twelve months are included. The medical officer of Stormont House reports as follows :—
" The progress of the children at the school has been most satisfactory. The above statistics
show that every child has gained in weight, while the numbers discharged as fit for work
together with those who have regained sufficiently in health to enable them to attend the
elementary school, are distinctly encouraging. In view of the satisfactory results of treatment
at this school it is regretted that the accommodation could not be increased by the formation
of an additional class."
The following report was received from the Medical Officer of Springwell House School:—
" The general health of the children attending the School is good. There have been few
cases of any serious illness amongst the children during the last year. The amount of infectious
disease has been very small .... During 1921, an old scholars' club was formed on
the initiative of the Head Teacher. The club meets in the evening six times during the year,
and I am informed that about twenty-five usually attend."
As in 1920, the Council arranged with the I.C.A.A. for children attending the Council's open air
schools for tuberculous children, whose parents were unable to take them away for a holiday, to be
sent for a fortnight's holiday. 220 children were sent away, the Council making a grant of £550 towards
the cost of maintenance and travelling expenses. 129 boys were sent to Ampthill and 91 girls were sent
to St. Leonards-on-Sea.
Tuberculosis
dispensaries.
Reference was made in last year s annual report (Vol. 111., pp. 36-7), to the Council s action
for the improvement and development of the tuberculosis dispensary service. The reforms were directed
principally towards securing that the dispensaries are used as specialist consultation centres and as the
medium for the early detection of the disease and other preventive work, treatment being limited to cases
requiring special knowledge or skill or for persons who are not in a financial position to obtain private
medical advice.
A further inspection of the dispensaries made by Dr. Knobel during the autumn of 1921, indicated
that the Council's action had reduced the congestion caused by prolonged periods of observation in
doubtful cases and by extensive treatment by patients with drugs, but that there were still misconceptions
as to the functions of the dispensaries. In this connection the problem of the advanced case is
once more brought into prominence. Both on grounds of humanity and for precautionary purposes
the tuberculosis officers feel it incumbent to visit these patients and to keep in touch with home conditions,
with the result that a good deal of time, which could be more effectively devoted to the fundamental
purposes of the dispensary service, is occupied with these cases. No satisfactory solution of
this problem in London has yet presented itself. Segregation in small local Homes for advanced cases
was at one time favoured, but it is now feared that, apart from the high cost of running small institutions,
the stigma of being labelled Homes for the Dying would make them unpopular. It is now felt that
large institutions at a long distance from the patients' homes would be equally unsuccessful owing to
difficulty of visitation by friends. In Paddington as an experiment the tuberculosis officer has been
appointed as a visiting consultant at the Infirmary, and it would appear that as the patients come
under his personal observation they are less reluctant to enter the institution. This matter is engaging
the attention of the Council. There is evidence that the tuberculosis officers are not yet fully acquainted
with the incidence of tuberculosis in their areas. Many cases are notified under the Tuberculosis
Regulations, 1912, only a short period before death, or even at death. Closer co-operation between
the medical practitioners and the tuberculosis officer is necessary in order to secure consultation with
the tuberculosis officer at an earlier stage when general practitioners have patients who present
suspicious symptoms, and also examination by the tuberculosis officer of contacts of definite cases.
It has not been possible to carry out the arrangements referred to in the last report for grouping
three or four dispensaries with a hospital equipped with observation beds for purposes of obtaining prompt
diagnosis in difficult cases. Observation beds have been mainly obtained by the Council in two hospitals
(Brompton, and City of London Chest Hospital, Victoria Park) and it has been found necessary to revert
to the original requirement that all the dispensaries shall be linked with the out-patients' departments
of hospitals for the purpose of securing the necessary aids to diagnosis (e.g., X-ray), and special forms of
treatment in difficult cases. The recent inspection of dispensaries, already referred to, has further
shown that for various reasons some tuberculosis officers are still reluctant to take full advantage of these
special facilities. On the other hand, there has been a tendency in some cases to make unnecessary use
of X-ray examinations for purposes of diagnosis. As a rule, patients should not be referred for X-ray
examination for purposes of diagnosis if tubercle bacilli have been found in the sputum, and three
examinations of sputum with negative results should be made before resorting to X-ray examination.
Mental
Deficiency
Act, 1913.
Action with regard to dispensaries is described in Chapter XXVII.
On 31st December, 1921, of the 2,455 cases being dealt with at the expense of the Council there
were—in institutions, 1,062 ; under guardianship, 16 ; under supervision, 1,355 ; in places of safety
awaiting other action, 22. There remained 2,446 out of the total number of 4,901 cases of alleged mental
defect, of which notice has been received since the Act came into operation. These cases include 286
in which no action could be taken ; 917 ascertained to be not defective, or to be not London cases ; 413
dealt with through the Poor Law ; 482 removed from the register (died, discharged, or removed to mental
hospitals or state institutions) and 348 still under consideration. During the year, 772 cases were
examined with the following results:—
Type.
Mule.
Female.
Total.
Type.
Male
Female.
Total.
Idiot 15 14 29 Not defective 21 41 62
Imbecile.117 87 204 Insufficient evidence 1 15 16
Feeble-minded 219 238 457 Total 375 397 72
Moral imbecile 2 2 4