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105
to function in a satisfactory way. Dr. Chaikin in the eastern division gives the
following account of this side of the work:—
"When tuberculosis dispensaries in London came into being a degree of contact
was established between them and the school medical service. Children were sent
to these institutions for an opinion and it became possible to obtain reports. Cooperation
developed subsequently when the tuberculosis officers nominated for
observation to the divisional medical officers "unsatisfactory" children, so called
because either their past medical history or their physical state at the time, not
necessarily definitely tubercular, rendered them unsatisfactory, and called for
periodical special supervision. It was considered that these children could, conveniently,
be examined by the school doctors and by their withdrawal temporarily
from the dispensaries relieve the tuberculosis officers for other duties. At this stage
contacts were not included.
The time came when, with the growth of co-operation between the London
County Council and the borough councils, it was arranged that children of school
age who were contacts with sufferers should be reported to the divisional medical
officers by the tuberculosis officers for observation, and, in doing so they were
requested to state on the form M.O. 333 whether they were "satisfactory" or
"unsatisfactory." An important feature of the scheme was that it embraced
children contacts who had failed to attend the dispensaries for examination.
From 1923 it has been the rule that the children nominated should be weighed
periodically and re-examined by the school doctors at intervals of six months, in
unsatisfactory cases, and nine months in "satisfactory" cases, and to be reported
back to the tuberculosis officers when further observation appeared unnecessary.
In the light of further experience the scheme was somewhat modified subsequently,
in respect of "satisfactory" contacts, by the examination of selected
children only, such as, where the original case might be infectious and where the
home conditions are unsatisfactory or where medical treatment is indicated.
There are five tuberculosis dispensaries in this division. Three of these are in
Stepney, one in Bethnal Green, and one in Poplar. 3,809 children were reported
contacts for observation by the tuberculosis officers during the five years: 1,138
in 1923; 950 in 1924; 726 in 1925; 445 in 1926; and 410 in 1927, up to November
18th. The high figure in 1923 included children from previous years, and the numbers
in 1926 and 1927 show a decline of nearly 50 per cent, in comparison with 1924.
This is due to a decrease in the number nominated from the Whitechapel and Poplar
dispensaries.

In all three boroughs the numbers notified in 1926 are less than in 1923. The
difference is most marked in Bethnal Green. The number of contacts reported to
the school medical service for observation cannot be said to have a direct ratio to
the number of notified cases, as the tuberculosis officers may retain some of them
for observation and the number of children in families varies.
"Unsatisfactory" children, contacts or not, numbered 917, and there were
2,416 "satisfactory contacts." 476 children, whose parents refused to bring them
to the dispensaries, were reported, and, with few exceptions, examined by the school
doctors. Every case on notification by the tuberculosis officer has been reported
to the care organisation with a view to any required action being taken.