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All those already mentioned social, nutritional, occupational and psychogenic
conditions which contribute to breakdown of health are the conditions which must be
mitigated or avoided so that natural resistance to spread of disease in the individual is
enhanced.
Tuberculosis services in London
Services
1. Provided by hospital authorities
Diagnostic and treatment facilities for pulmonary and non-pulmonary cases of
tuberculosis are provided at practically all the hospitals in London of the four Metropolitan
Regional Hospital Boards, the University 'Teaching' Hospitals and the special
hospitals and clinics for chest diseases, children, eye diseases, skin diseases, orthopaedics,
gynaecology, genito-urinary diseases, etc.
The pathology laboratories of these hospitals and of the Medical Research Council
(which also operates a Tuberculosis Research Unit at Hampstead) make a special and
valuable contribution to the services provided for dealing with tuberculosis. The X-ray
departments of these hospitals and the static and mobile mass X-ray units of the
Metropolitan Regional Hospital Boards provide the main diagnostic armament.
A special report on the operations and findings of mass X-ray services available to
Londoners follows on page 35.
Hospital treatment made available by these authorities for tuberculous Londoners
is now—apart from facilities simply for segregation of the infectious consumptive—
ample. Long waiting periods for admission to hospital now affect only cases for surgical
treatment of lung disease. An increasing tendency has been manifest in recent years
for cases to be treated in bed at home under the supervision of specialist chest physicians
and at their request nursing and other facilities—described in detail later—are provided
by the London County Council for such cases.
2. Provided by the London Executive Council
The general practitioners in the London area provide valuable and valued service
in general medical supervision and supportive guidance to patients, as well as being
the first usually to initiate diagnostic investigation in patients suspected of having chest
or other forms of tuberculosis. Their contribution is widespread, influential and unostentatious.
In the preventive field they are valued allies in encouraging families to
accept the services offered by the London County Council.
3. Provided by the London County Council
Services for the adult patient
Home care
The Council, as local health authority, has the duty of providing for the ' care and
after-care ' of London tuberculous patients after hospital treatment and during treatment
at home or chest clinic.
The Council's specialist tuberculosis health visitors, in addition to working as chest
clinic nurses, visit patients in their homes to advise on matters of hygiene, to ascertain
home conditions and needs, and to persuade contacts to attend the clinic. Its domiciliary
nursing service provides home nurses who give nursing attention under the direction
of the family doctor or clinic chest physician. Nursing equipment, such as back rests,
surgical mattresses, bedpans, sputum flasks, etc., is made available on loan to patients
in need. Patients unable to make their own way to the local chest clinic for consultation,
X-ray, pneumothorax treatment, etc., may be conveyed by ambulance or sitting-case
car provided through the Council's ambulance service. Where garden space permits,
the Council supplies on loan and erects wooden 'chalets' for infective patients at home
so as to provide a separate 'room' and reduce close contact with young members of
the household. The Council employs home helps to undertake domestic duties in the
homes of bed-fast patients and to care in the home for the children of mothers undergoing
treatment.
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