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28
During the past three years, special attention has been given to the question
of diagnosis of pulmonary tuberculosis in children. The negative sputum cases of
pulmonary tuberculosis (classified as A cases) have always been difficult to assess.
In adults this problem has been of less difficulty as diagnosis has always been more
precise, and the proportion of cases on which doubt as to the accuracy of diagnosis
might be cast (i.e., those in which the bacilli have not been found) has been relatively
small. Thus, in 1929, the proportion of adult pulmonary cases (classified as A cases)
discharged from treatment was only 16.25 per cent. In children, however, the
opposite state of affairs has been the case, the majority of children receiving treatment
for pulmonary tuberculosis being negative sputum (i.e., class A) cases. In 1929 the
proportion of child pulmonary cases (classified as A cases) discharged from treatment
was 78.17 per cent.
In the absence of definite diagnosis, there has been a tendency to label a delicate
child "tuberculosis" in order, most easily, to obtain for it a period of residential
treatment or convalescence. The enlargement of the powers of the Council by the
Local Government Act, 1929, has enabled the Council to provide convalescence and
observation for such children.
No child is now treated under the Council's tuberculosis scheme for a prolonged
period in a residential institution without substantial evidence as to the presence of
tuberculous disease. All "doubtful" children are now subjected immediately to
a critical period of investigation at High Wood hospital, and an increased number
are quickly discharged as non-tuberculous.
This insistence on stricter diagnosis has made it possible to reduce the number
of beds for children in voluntary institutions. Further, since the autumn of
1931 no child has been placed in a fully equipped voluntary surgical institution
unless there have been very exceptional circumstances to justify such a course. It
is estimated that, in this way, a saving of approximately £5,000 per annum has been
effected.
The development of the Council's tuberculosis scheme over a period of
approximately twenty years has been gradual and may now be regarded as comprehensive.
As from 1st April, 1933, all residential treatment of tuberculosis will be provided
under the Council's tuberculosis scheme.
As regards adults, it is proposed to continue the use of the Council's general
hospitals for emergency cases and for bedridden or mainly bedridden advanced
chronic cases, and to some extent for "observation" purposes to assist in determining
future treatment. It is also proposed to continue the existing arrangements for
the immediate admission to the general hospitals of urgent and acute cases on direct
application to the medical superintendents by patients, tuberculosis officers, district
medical officers and private medical practitioners. Other cases will be dealt with
under the general procedure laid down in the tuberculosis scheme, the applications
being received, as a rule, through the tuberculosis officers.
The Council's special hospitals and sanatoria have been classified so as to provide
for the distribution generally of patients according to classes distinguished as "early,"
"moderately advanced "or" advanced" cases; the "early" cases going mainly
to King George V sanatorium (men) and to Pinewood sanatorium (women); the
"moderately advanced" cases and "advanced" cases with prospect of improvement
to Colindale hospital (men), Grove Park hospital (men and women) and Northern
hospital, Winchmore-hill (women). St. George's home, Chelsea, is used for "observation"
purposes in determining the future treatment of women who have been
notified as definitely tuberculous. These arrangements are modified according to
need. St. Luke's hospital, Lowestoft, is used for surgical cases of both sexes, and