View report page

91
visitors, tuberculosis care organisers and their clerks, and handicraft instructors. Most
of the health visitors' time is spent in visiting patients in their homes to ascertain the
domiciliary, social, and economic conditions under which the patients live to provide a
basis for measures to improve them. The care organisers are concerned with the patient's
social needs other than medical and nursing. They also act as the secretaries to the local
tuberculosis care committees, whose activities are co-ordinated by divisional tuberculosis
care committees.
T.B. visitors
The tuberculosis visitor remains an important link between the diagnostic and curative
work at the chest clinic and the preventive and care measures in the patient's home.
She works in association with the chest physician while remaining under the local
direction of the Council's divisional medical officer. She is in touch with the hospital
services and voluntary home nursing organisations and, as regards after-care measures
in the home, with the tuberculosis care organiser. Tuberculosis health visitors are
provided by the Council to work in chest clinics at an average spread of one visitor to
400 registered tuberculous patients. The introduction of a scheme for B.C.G. vaccination
has added to her clinical duties. The increasing number of epidemiological investigations
carried out as a result of cases of tuberculosis at schools, nurseries and welfare homes
has also to be taken into account. In order to relieve generally the pressure of nursing
work at the clinic it has been necessary at certain chest clinics to employ state registered
nurses.
The importance of relieving tuberculous patients of domestic, social, industrial and
financial anxieties cannot be over-emphasised. Most necessitous tuberculous persons
receive a higher rate of financial grant from the National Assistance Board than do other
necessitous persons. In 1952, clinic care organisers made first investigations in respect of
5,951 patients; 2,559 newly assisted patients received extra nourishment; 541 were
provided with beds and bedding; 496 were provided with nursing requisites; 961
were provided with clothing and 606 with other commodities. At the end of the year
2,234 tuberculous patients were receiving extra nourishment from the Council or care
committee resources and 673 were receiving the services of home helps. In addition to
arranging for the provision of food, clothing, etc., as outlined above, the Council's
care organisers made arrangements, where possible, for better housing, more suitable
employment, foster homes for child contacts, diversional therapy, and gave help or
guidance in many other problems of personal or family concern.
Home care
and
treatment
At the end of 1952, there were 738 tuberculous persons in London awaiting admission
to hospital, compared with 773 at the end of the previous year; 808 patients (compared
with 658 at the end of the previous year) were under special treatment in their own
homes. Many of these were awaiting admission to hospital, but where the patient's
domestic and home conditions permitted, chest clinic physicians introduced home
treatment by rest, chemo-therapy, collapse therapy, or combinations of these forms of
treatment. This treatment involved the services of health visitors, home nurses and home
helps, and the boarding-out of susceptible children from the homes to avoid the risk of
infection or to ensure their safety and care while mothers were undergoing treatment at
home or in hospital. At the end of the year 367 patients were receiving attention by the
Council's home nursing service.
The Council's ambulance service rendered valuable assistance to the home treatment
scheme by conveying many patients by car or ambulance from homes to clinics or
hospitals for X-ray examinations, for lung collapse therapy, or associated minor surgical
treatment.
Domestic
help
The Council has recruited a body of home helps willing to work in tuberculous
households and they are advised by printed notice to take certain precautions whilst
employed on this work. There has been a steady increase in the number of tuberculous
persons receiving domestic help (536 at the end of 1951, rising to 673 at the 31st
December, 1952). The use of home helps when mothers are in hospital or in bed at
home enables the family to keep together and reduces work and anxiety for the patient.