London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1936

[Report of the Medical Officer of Health for London County Council]

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44
Thus detailed inquiry has shown that of these 19 children reported dead, three
were found to have yielded tubercle bacilli on one or more occasions when under
residential treatment but this had not been recorded centrally. Such cases, of
course, properly fall within the "B" group. A further three cases died from
other (non-tuberculous) conditions.
The following are short notes of the remaining 13 T.B. minus cases, who died
from pulmonary tuberculosis, indicating the condition found whilst under residential
treatment:—
(1) Deposits throughout right lung and at left apex.
(2) Advanced pulmonary tuberculosis, 5 lobes, with possible enteritis; grave constitutional
disturbance.
(3) Miliary tuberculosis; grave constitutional disturbance.
(4) Extensive foci in each lung; grave constitutional disturbance.
(5) Left apex; signs of cavity; prolonged pyrexia.
(6) Pleural effusion, air replaced and maintained as artificial pneumothorax; suspicious
upper lobe other side.
(7) Probably both upper lobes (T.B. in sputum and extensive bilateral disease 10 months
later).
(8) Suspicious case only; treated at residential open-air school.
(9) Pleurisy and meningitis.
(10) Old tuberculous spine; pleural effusion; subsequent re-activation of spine and
culous meningitis.
(11) Consolidation right middle lobe; haemoptysis.
(12) Bilateral pleural effusion.
(13) Mass of glands in both roots; moist sounds all over chest; grave constitutional
turbance; probably acute generalised tuberculosis.
It will be seen that, with the exception of case no. 8, no child died of pulmonary
tuberculosis who was not seriously ill at the outset.
Up to the present time it has been possible to trace 140 survivors, whilst 12
cases still remain untraced. Of the 140 traced survivors, as many as 121 (86.4 per
cent.) are well and at full work or school, whilst 26 of them have been removed from
the tuberculosis registers as "recovered." Without a doubt many more are capable
of such decertification if the definition were sufficiently strictly applied, and these
will shortly be dealt with in this manner. Of the remaining 19 survivors who are
not known to be at full work or school: 1 has arrested tuberculosis but suffers from
chorea; 2 are fit for work but unemployed; 2 are arrested cases doing part-time
domestic duties; 4 are unfit for work because of their disease; and 10 have not
attended at a dispensary and information is incomplete.
It is interesting to note that, of the survivors, 19 had subsequent residential
treatment for tuberculosis, 12 having further periods during childhood, whilst 7
underwent treatment as adults. Of the 12 subsequent periods of treatment during
childhood 10 were treated again as T.B. minus cases, and two for surgical tuberculosis.
Of the 7 treated later as adults, 4 had developed positive sputum, there
being an average interval of 2 years since discharge after the original period of
treatment; 2 were treated at Burrow Hill colony as T.B. minus cases whilst another
developed a tuberculous hip.

To summarise, the final figures arrived at after a careful study of the T.B. minus children discharged from treatment in 1930 are as follows:—

No.Percentage
Untraced127.3
Traced15392.7
Alive14091.5 of traced cases.
Known to be well and at full work or school12179.1 „ „
Died from tuberculosis138.5 „ „
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These results are, it will be generally conceded, remarkably good.
In addition to the foregoing after-history investigation, Dr. F. J. Bentley in
collaboration with medical superintendents of the Council's (formerly Metropolitan
Asylums Board) and voluntary sanatoria, has conducted a detailed investigation
into the results of artificial pneumothorax treatment provided for the Council's
patients between the years 1921 and 1930. The cases were examined as regards


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