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It is gratifying to note that only one of the cases classified last year as quiescent
or arrested has become active.
In addition a large number of contacts are kept under observation.
(B) Patients non-resident in the City.
(a) Who work in the City.
On diagnosis these patients are informed that they can be treated and advised
at the Dispensary or transferred to the Tuberculosis Officer of their own Borough.
The majority decide to remain patients at the Dispensary.
(b) Who do not work in the City.
On diagnosis these patients are transferred to the Tuberculosis Officer of
their own Borough, so none are treated here.
TOTAL ATTENDANCES
Insured.
Non-Insured.
Total
Residents 193 456 649
Non-Residents 800 763 1,563
2,212
THE TUBERCULOSIS NURSE.— The work of the Tuberculosis Nurse has
been continued on the same lines as former years. 90 homes have been visited
and 647 visits made in connection with after care and following up. In addition
to the above, patients, some of whom were in an advanced stage of the disease,
have been nursed in their own homes. 12 of these cases terminated fatally. For
nursing purposes 51 visits were paid.
GENERAL.— The following information is supplied in accordance with the
requirements of the Ministry of Health. The paragraph numbers correspond with
those in Circular 168, and where a number is omitted the subject matter does not
concern City work :—
(i.) The Tuberculosis Dispensary is at St. Bartholomew's Hospital ; the Tuberculosis
Officer is Dr. F. H. Young, O.B.E. ; one Tuberculosis Nurse is engaged in the work. Treatment
in residential institutions is provided for insured and uninsured persons by the London
County Council.
(iii.) Patients are referred to the Tuberculosis Dispensary from hospitals, school clinics
and other institutions, with all of which there is close co-operation.
The services of the Staff and all the resources of St. Bartholomew's Hospital are available
for diagnosis and treatment. Many patients are referred to departments of the Hospital
for these purposes.
(iv.) The Tuberculosis Officer is in constant consultation and communication with
general practitioners, so that there is close co-operation between them and the Dispensary.
He reminds them when reports are due on insured patients under domiciliary treatment
and provides them with copies of the form with names and addresses inserted.
(v.) When the diagnosis is in doubt and the patient is under the care of a practitioner,
arrangements are made with him for re-examination ; in other cases arrangements are made
with the patient, but should he fail to attend, either the Tuberculosis Nurse calls upon him
or he is reminded of the appointment in writing.
(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.) Considerable use is made of X-rays from the point of view of diagnosis and decision
as to method of treatment to be recommended.
The usual methods of treatment have been continued in the Dispensary. Tuberculin
has been used in a few cases. In addition, three cases of pulmonary tuberculosis are attending
for the continuation of their treatment by artificial pneumothorax. It is hoped to use this
very promising method of treatment in suitable cases as they arise.
(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 £20 has been expended.