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41
Further factors in removing former obstacles to the effective use of the
general hospitals as an integral part of the arrangements for dealing with tuberculosis
in London are (a) the appointment of tuberculosis officers as honorary consultants
on the staff of the general hospitals, with provision for regular visits to the hospitals,
and (b) the close relationship which has been established between the medical superintendents
of general hospitals and the central staff at County Hall responsible for
the appropriate distribution of patients.
Immediate admission can be secured to the general hospital nearest to the
patient's home by direct arrangement between the tuberculosis officer or the patient's
medical attendant and the medical superintendent, or if there is no vacant bed, to
another general hospital. Some patients prefer to be sent to a hospital other than
that serving their home address on account of some prejudice or other, such as that
a relative died in the hospital, or that they prefer another district because of the
"change of air" or some other reason. Wishes of patients in this matter are met as
far as possible.
Patients are continually leaving the general hospitals to go to sanatoria. Those
.entering the general hospitals are consequently relieved of the sense of hopelessness
which formerly prevailed among patients offered treatment in these hospitals.
Seriously ill patients in increasing numbers now consent to enter the general
hospitals.
The greater readiness of patients to accept transfer from sanatoria to the general
hospitals is seen in the following figures giving the cases transferred from sanatoria
to the general hospitals during the years 1928.34:—
Year. Number. Year. Number.
1928 117 1932 515
1929 155 1933 598
*1930 302 1934 649
1931 444
* The general hospitals were transferred to the Council on 1st April, 1930.
Improvements have been effected in the general hospitals and among the
advantages arising from their use for tuberculosis scheme patients, are the following:—
(i) Patients developing complications (tuberculous or non.tuberculous)
which cannot be treated effectively in tuberculosis hospitals or sanatoria can be
transferred to a suitable general hospital, and return to a special tuberculosis
hospital or sanatorium when the complication has been treated.
(ii) The value of the direct transfer of advanced bedridden cases to general
hospitals in London is reflected in the greater popularity of such institutions
as Colindale hospital, Hendon, and Grove Park hospital, Lee, where there has
been a considerable reduction in the number of deaths and self.discharges.
(iii) Pregnant tuberculous women are now admitted into Grove Park hospital,
Lee, where they can receive sanatorium treatment up to the time of confinement,
and, at the same time, attend the ante.natal clinic at Lewisham hospital (which
is situated close to Grove Park) and to which they are admitted for the actual
confinement, afterwards returning for completion of treatment for tuberculosis
to Grove Park hospital or other suitable tuberculosis hospital or sanatorium.
(iv) Units for thoracic surgery have been established at two general
hospitals (St. Andrew's, Poplar, and St. James', Wandsworth). There is also a
panel of consulting thoracic surgeons and other consultants in connexion with
both the general and the special tuberculosis hospitals and sanatoria, several
of the latter now having operating theatres for the surgical treatment of
pulmonary tuberculosis.
(v) Beds in the general hospitals are occasionally used for observation
purposes to determine the most suitable disposal of patients for treatment.
(vi) A number of auxiliary services for patients having domiciliary treatment
in association with the tuberculosis dispensary service, such as the provision
of artificial pneumothorax refills, X.ray examinations and dental treatment,
in respect of which some dispensaries found difficulty in securing the necessary