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In view of the fact that the cases in the last stages of the disease are extremely infectious,
cspccially in crowded houses, the Corporation have made arrangements to pay for the maintenance
of selected City cases at St. Columba's Hospital, Swiss Cottage, and at St. Joseph's
Hospice, Hackney. No case was admitted in 1938 to these institutions.
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. One patient was so admitted during the year.
Iilood Examinations.—During recent years a new method of examination by means
of the estimation of the Red Cell Sedimentation Rate has become a routine at the Dispensary.
This examination has been performed on 172 occasions. Sixty-eight were performed on
patients resident in the City. The examinations were extremely helpful in estimating the
activity and progress of the disease.
Artificial Pneumothorax.—This method of treatment is being increasingly employed,
and its value is beyond doubt. The conduct of the cases should be controlled accurately
by floroscopic examinations made prior to the introduction of air into the patient's chest.
Many failures which have occurred when this treatment has been used are due to lack of
floroscopic, control. At the City Dispensary this examination has been carried out on
every occasion prior to a refill.' During the year 443 refills were performed on 24 cases—
5 resident in the City and 19 non-resident.
A number of patients who are not resident in tjie City have been treated on behalf Qf
other Local Authorities and payment made to the City Corporation for the work done.
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. Thirty-six homes have been visited, and' 293 visits made in
connection with after-care and following up, and four in connection with City deaths.
The Clerical work in connection with the Dispensary, which is increasing every year,
is carried out by these Officials. It has been necessary, however, to give them some assistance
in this connection, and that has been arranged through part-time help by one of the staff of
St. Bartholomew's Hospital. A somewhat complicated system of records has to be kept to
provide material for the detailed returns furnished for the Ministry of Health at the end
of each year. Reports are furnished each month to the City Medical Officer of Health,
and progress reports of all patients who have been treated in a London County Council
Institution are sent annually. Great care has been taken that a full detailed clinical report
is sent to every doctor who sends up cases to the Dispensary. To facilitate this work,
arrangements have been made by the City Corporation with St. Bartholomew's Hospital,
by which a small office has been provided adjacent to the Dispensary.
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.
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