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During past years a certain amount of difficulty has arisen in connection with the
residential treatment of cases who were residing at the place at which they were employed,
when diagnosed as having pulmonary tuberculosis. In order to meet this, the Corporation
have made an arrangement with the Brompton Hospital whereby urgent cases can be
admitted within 48 hours under Dr. Young's personal care, under a Certificate from the
Medical Officer of Health. Four cases have been admitted under this scheme during the
year.
Artificial Pneumothorax.—Artificial pneumothorax treatment has been used again
during the year. Artificial pneumothorax refills were done on 30 occasions for City and
233 occasions for non-City patients, in connection with the Dispensary.
The Tuberculosis Sister and Nurse.—As an adjunct to the work at the Tuberculosis
Clinic, the outside work of the Tuberculosis Sister and Nurse has been continued on the
same lines as former years. Sixty-two homes have been visited, and 169 visits made in
connection with after-care and following up, and four in connection with City deaths.
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 and one Tuberculosis Nurse
are 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 doctors, 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 Tuberculous 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 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,
2 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, 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. (Two patients were so provided during 1936.)
(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 £26 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.