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(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, †
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
with the original case and for two years after this had ceased. The objection to this system
was mainly psychological; either the contact attended regularly and worried about the
possibility of contracting tuberculous disease, or failed to attend after the first time owing
to carelessness or fear that something would be discovered. In addition, there is a considerable
change of population in and out of the City, and contacts who left the City were
completely unprotected. Probably, owing to the fact that they had been examined and
told originally that there was no evidence of tuberculosis, they were likely to be more negligent
about symptoms than they normally would be.
The number of people who subsequently develop pulmonary tuberculosis as a result
of contact during adult life, provided they show no evidence of heavy tuberculous infection
when they are X-rayed, is very small, and it seemed possible that a considerable amount of
psychological damage was being done by the system in operation.
The new system is to examine each contact case thoroughly at the time when the
original case is discovered. If no evidence of tuberculous disease or heavy tuberculous
infection is discovered, they are informed of this and given a pamphlet telling them that
there is no need to worry unless they develop any of the common symptoms which occur
as a result of the onset of tuberculosis, and advising them of the course to take if symptoms
do develop. The pamphlet which is given to them is shown in Appendix E.
The method of dealing with non-adult contacts has not been changed, as most of the
considerations noted above do not apply. Of course, this alteration of method does not
mean that any abatement has been allowed in the hygienic measure which are applied to
infectious cases.
TUBERCULOSIS DISPENSARY.
TRAINING OF HEALTH VISITORS.
The Corporation have placed at the disposal of the College of Nursing the facilities
available at their Tuberculosis Dispensary, in order that that body can give to their health
visitor students a short course of practical experience in tuberculosis work, as undertaken
by a tuberculosis nurse.
Appreciation has been expressed on every occasion when advantage has been taken
of these opportunities, although during 1936 the facilities were not used.
ARTIFICIAL PNEUMOTHORAX TREATMENT.
At the request of the Authorities of one of the Home Counties, artificial pneumothorax
has been administered to one of the patients under their control, and an appropriate fee
charged.
† The present lady members of the Committee are Miss Crosby, M.B.E., and Lady Smith, J P.
D2