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77
Tuberculosis
Throughout the year the Council continued to provide its share of the National
Health Tuberculosis Service, the diagnostic and therapeutic aspect of which is
dealt with by the hospital boards. Considerable and sometimes complex and delicate
integration and liaison with the Metropolitan Regional Hospital Boards, the Boards
of Governors of Teaching Hospitals and Hospital Management Committees is
necessary in order to ensure that the available resources are used to the best advantage
for tuberculous persons and their families.
Chest
clinics
There are 29 chest clinics in the county, with two in some of the larger boroughs
and with occasional combinations of boroughs covered by one clinic. The medical
staff, the radiographer and the physicians' clerks are provided by the hospital boards,
who also provide the premises and equipment. The Council rents accommodation
for the staff it provides, which includes an after-care organiser, a clerk for the latter,
a handicraft instructor, and a varying number of tuberculosis health visitors who
spend part of their time assisting the physicians in clinic work and rather more
of their time visiting patients in their homes so as to ascertain and, where needed, endeavour
to improve, the domiciliary, social and economic conditions under which
the patients live. The after-care organiser at the clinic is concerned with the
patient's needs other than medical and nursing; she also acts as secretary to the
local tuberculosis care committee. These clinics had on their books on 31st December,
1950, 32,301 patients, of whom 28,623 were suffering from the pulmonary form of
the disease.
Home
care and
treatment
At the end of September, 1950, there were 3,076 tuberculous Londoners undergoing
hospital treatment mainly in regional hospital board institutions, and 2,035
patients awaiting admission to hospital. There were also at that time 1,287 patients
under special treatment in their own homes ; many of these were awaiting vacant
hospital beds, a wait usually stretching to about six months so that anxious chest
clinic physicians, where housing circumstances permitted, increasingly introduced and
extended home treatment by rest, chemotherapy, collapse therapy or combinations
of such therapies. This multiplied the need for health visitor, home nurse and
home help services and increased the demand for facilities to " board-out" susceptible
home contacts to avoid the risks of infection or to reduce the burden of
domestic labour from an ill mother for whom rest in bed at home was prescribed.
By the end of the year the number of patients under special domiciliary treatment
had risen to 1,678 and the waiting list for admissions to hospital had fallen to 1,513.
In the last quarter of the year 662 patients received attention by the Council's
home nursing service.
Consideration was given to the desirability of extending the clinic service of
diversional therapy to patients bedfast or "homefast" but for various reasons the
introduction of such a service has had to be postponed.
The Council's ambulance service was also taxed by this increase in home treatment
inasmuch as many of the patients so treated had to be brought repeatedly
by car or ambulance from home to clinic or hospital for X-ray examination or for
lung collapse therapy or minor surgical procedures associated therewith. Many
chest clinic physicians have expressed their satisfaction at the full and convenient
arrangements made to this end by the officers of the ambulance service.
After-caro
organisers
and local
Care
Committees
Increasing awareness of the importance to tuberculous patients of relieving them
of domestic, social, industrial and financial anxieties has led to an increase in the
activities of local Care Committees and of after-care organisers. In the last quarter
of 1950 these officers made first investigations in respect of 1,574 patients. During
these three months 160 newly assisted patients received extra nourishment; 731
received the services of home helps; 190 were provided with beds and bedding;
213 were lent nursing apparatus; 284 were provided with clothing and 89 with