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(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 pneumo-thorax and inductions of the treatment have been performed
in three cases in the wards of the Hospital.
(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 £35 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 as 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 method 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 quiescent. 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.
(xviii.) Difficulties also arise with regard to advanced cases. These are usually very
infectious and do not care to go to the infirmary. This has been largely remedied by the
arrangement made bv the Corporation already referred to.

Of the ten deaths recorded above, one or 10 per cent. referred to a person who had
not been notified as suffering from Tuberculosis. This case, a Pulmonary case, was a
man of 46 years of age who died of acute Miliary Tuberculosis. The disease was not
determined until after death.
* The present lady members of the Committee are Lady Cooper, O.B.F., and Miss Crosby, M.B.E