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(vi.) The Tuberculosis Officer explains to the patients the importance of the examination
of home contacts, and in addition to the necessary visits of the Sanitary Inspectors the
Tuberculosis Nurse visits the homes of City residents periodically for the same purpose,
and arranges for the attendance of the contacts at the Dispensary at times convenient to them.
The supervision of these contacts, and the re-examination of suspects among them, is
secured by the home visits periodically made by the Nurse.
(vii.) X-ray photographs of 30 patients have been taken during the year, and have
proved of value as an addition to the usual methods of diagnosis.
No special methods of treatment have been adopted in the Dispensary. Tuberculin
has been used for a few cases.
(viii.) Experience shows that when the disease is active, residence in an institution
more quickly and certainly brings about arrest than when treatment is attempted at home
on sanatorium lines, and that the lessons learnt in the sanatorium are sometimes put into
practice by the patient on his return home to his permanent advantage.
(ix.) Dental treatment is provided by the Dental Department of St. Bartholomew's
Hospital, and the Corporation defrays the whole or part of the cost of artificial dentures
for necessitous cases.
(x.) Nursing in their own homes of patients resident in the City is one of the duties
of the Tuberculosis Nurse. Milk has been provided for necessitous persons requiring extra
nourishment and in this connection the sum of £28 has been expended.
(xi.) Patients suffering from Non-pulmonary Tuberculosis receive advice and treatment
from the Surgeons of St. Bartholomew's Hospital, to whom they are referred from the
Dispensary. Treatment in residential institutions is provided as for pulmonary cases. The
Corporation supplies surgical apparatus free of cost for necessitous residents in the City.
(xii.) The arrangements for " care " and " after care " are carried out by a subcommittee
of the Sanitary Committee, on which two ladies are co-opted members. It
receives detailed reports on all cases of Tuberculosis occurring among City residents.
(xiii.) No local arrangements exist for providing employment for patients.
(xiv.) No opportunity has arisen for the use of a shelter, but arrangements would be
made for any suitable case if a site were available.
(xv.) No special points have been noted as to the incidence of Tuberculosis ; the records
do not show that the disease is specially prevalent among any class of workers in the City.
(xvi.) The usual methods for preventing the spread of infection are adopted, and
pocket sputum flasks are provided free of cost.
(xvii.) The principal difficulty encountered occurs on the discharge of a patient from
a sanatorium with the disease arrested. The home environment to which he returns is often
unsatisfactory ; suitable occupation near his home may be practically unobtainable, even
when remuneration is not the main consideration, and the very considerable benefit gained
is in some cases soon lost and the treatment in the sanatorium largely wasted.
CONSUMPTION—SPITTING.—The objectionable habit of spitting in the
streets and other public places, and also the corridors of large buildings occupied
by a number of different firms, is still a source of nuisance. Precautionary notices
issued by the Corporation drawing attention to this practice are distributed to
bona-fide applicants.
PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1921.
The issue of Public Health (Tuberculosis) Regulations, 1921, which amend in
certain respects the Public Health (Tuberculosis) Regulations, 1912, was necessitated
by the passing into law of the National Health Insurance Act of 1920, in
accordance with the provisions of which sanatorium benefit under the National
Insurance Act, 1911, ceased as from the 30th April, 1921.
Treatment of both Insured and Uninsured patients in a Sanatorium is now the
responsibility in London of the London County Council.
The first article of the new Regulations consists of the citation and date of
operation, and the second is confined to the alteration of definitions of " Tuberculosis
Dispensary " and " Sanatorium."
The effect of Article 3 is to enable the Medical Officer of the Tuberculosis
Dispensary to have access to the register of notifications which the Medical Officer
of Health of the district is required to keep under Article XI. (2) of the Regulations
of 1912.
Article 4 requires that every Medical Officer of Health shall from time to time,
but not less often than once in every quarter, revise the register by removing from
it the entries relating to notifications in respect of persons who have to his knowledge
died or ceased permanently to reside in his district. In an area such as the
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