London's Pulse: Medical Officer of Health reports 1848-1972

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City of London 1932

[Report of the Medical Officer of Health for London, City of ]

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21
During past years a certain amount of difficulty has arisen with cases who were residing
at the place at which they were employed, when diagnosed as having pulmonary tuberculosis.
The provision of Residential treatment by the L.C.C. usually entails the patient waiting
two or three weeks before admission; under ordinary circumstances this does not cause
any difficulty, but with this particular type of case more prompt action is desirable. The
Corporation have now an arrangement with the Brompton Hospital whereby cases of this
type can be admitted within 48 hours under Dr. Young's personal care, under a Certificate
from the Medical Officer of Health. Five cases have been admitted under this scheme during
the year.
Artificial Pneumothorax.—Artificial pneumothorax treatment has been used again
during the year. Artificial pneumothorax was induced in two cases and 27 City and 289
non-City Refills done in connection with the Dispensary.
The Tuberculosis Sister.—As an adjunct to the work at the Tuberculosis Clinic, the
outside work of the Tuberculosis Sister has been continued on the same lines as former years.
Sixty-eight homes have been visited, and 297 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. For this purpose 21 nursing visits
were made.
General.—The following information is supplied in accordance with the requirements
of the Ministry of Health:—
(i.) The Tuberculosis Dispensary is at St. Bartholomew's Hospital; the Tuberculosis
Officer is Dr. F. H. Young. O.B.E.; one Tuberculosis Sister is engaged in the work. Treatment
in residential institutions is provided for insured and uninsured persons by the London
County Council.
(ii.) 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.
(iii.) 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.
(iv.) 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 Sister calls upon him
or he is reminded of the appointment in writing.
(v.) 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 Sister 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 Sister.
(vi.) 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,
3 City and 15 non-City cases of pulmonary tuberculosis attended for the continuation
of their treatment by artificial pneumothorax and inductions of the treatment have been
performed in several cases in the wards of the Hospital.
(vii.) Experience shows that when the disease is active, residence in an institution
more quickly and certainly brings about arrest than when the 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.
(viii.) 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.
(ix.) Nursing in their own homes of patients resident in the City is one of the duties
of the Tuberculosis Sister. Milk has been provided for necessitous persons requiring extra
nourishment and in this connection the sum of about £35 has been expended.
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