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81
Tuberculosis.
One of the most important objectives in connection with tuberculosis is undoubtedly
the earliest possible detection of the disease ; for this systematic examination
and supervision of child contacts if essential. To effect this the closest co-operation
between the school and the tuberculosis dispensary is required ; and as experience
of the scheme in operation by means of form M.0.33 showed certain directions in
which improvement could be made, the following modifications of the scheme were
drawn up.
Tuberculosis.
Form M.O. 333 will replace M.O. 33 ; the tuberculosis officer refers on
M.O.333:—
A.—All " unsatisfactory children," whether contacts or not, who, after observation
at the dispensary, are considered to be probably non-tuberculous, but who
require supervision. Brief medical particulars of each case are entered on the card.
B.—-All contacts who on first examination are apparently healthy, and also,
as far as possible, all other contacts that he has been unable to examine. The name,
date of birth, address, and school attended, are entered on the card, and each case
classified by the tuberculosis officer under one of the following headings. The card
is then sent to the divisional medical officer.
Class 1. An " unsatisfactory " child, whether contact or not.
Class 2. An apparently healthy contact; or
Class 3. A contact that has not been examined.
Procedure
in the
dispensary.
Class 1 are (a) examined by the school medical officer quarterly, and referred
back to the dispensary if at any time, in his opinion, the child should be regarded
as probably tuberculous. (b) weighed approximately monthly, and the weight
recorded on the chart.
Class 2 are (a) examined once a year ; (6) weighed quarterly.
Class 3 are examined as soon after reference as possible, classified by the school
medical officer, and dealt with as Class 1 or Class 2, as the case may be.
Once a year a conference is mutually arranged between the divisional medical
officer and the tuberculosis officer, at which records of all cases referred under the
scheme are reviewed, and the cases re-classified or discharged from further observation
Procedure in
the school.
Dr. F. C. Lewis submits the following report of the first year under the amended
scheme in the north-eastern division.
" I have met the tuberculosis officers working in this division, and with them
have reviewed the cases which have come under notice. The following table provides
an analysis of the results. The first column shows the total numbers referred to
me, the second column relates to the children who now appear to need no further
supervision, and the numbers of those who would apparently benefit by retention
in the scheme appear in column three :—
Dispensary. Total. Discharged. Retained.
Metropolitan Hospital 85 67 18
Royal Chest Hospital 399 306 93*
Victoria Park Hospital 48 28 20†
Royal Northern Hospital 76 66 10
608 467 141
* Including 21 for re-examination by tuberculosis officer.
† Including 2 for re-examination by tuberculosis officer.
In the eastern division, Dr. Chaikin reports during the same time that 1,137
school children were kept under observation of whom, 195 were discharged, the
remainder still being under observation. 297 were Class 1, 736 Class 2, and 104
Class 3. Twenty children of Class 1 were excluded from school.