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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 or Nurse.
(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 22 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, and the operations of thoracoplasty
and phrenic evulsion have been performed.
(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, but this year no visits in this connection were necessary. Milk
has been provided for necessitous persons requiring extra nourishment and in this connection
the sum of about £40 has been expended.
(x.) 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 for as in pulmonary cases.
The Corporation supplies surgical apparatus free of cost for necessitous residents in the City.
(xi.) The arrangements for "care" and "after.care" are carried out by a subcommittee
of the Public Health Committee, on which two ladies are co.opted as members.f
It receives detailed reports on all cases of Tuberculosis occurring among City residents.
(xii.) No local arrangements exist for providing employment for patients.
(xiii.) No opportunity has arisen for the use of a shelter, but arrangements would be
made for any suitable case if a site were available.
(xiv.) 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.
(xv.) The usual method for preventing the spread of infection is adopted, and pocket
sputum flasks are provided free of cost.
(xvi.) 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.
(xvii.) 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 by the Corporation already referred to.
For some time past the Tuberculosis Officer has been dissatisfied with the method in
use in dealing with adult "contacts" of cases of pulmonary tuberculosis, and a new scheme
has been used. The method previously used has been to examine each contact fully with
X.rays at the time when the original case was discovered; if no evidence of tuberculous
disease was discovered, the contact was seen periodically as long as contact was maintained
† The present lady members of the Committee are Miss Crosby, and Lady Smith, J.P.