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(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, 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 £he necessary visits of the Sanitary Inspectors, the
Tuberculosis Nurse 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.) Every patient attending the Dispensary'as a new case has had an X-ray taken,
and all patients who attend for further treatment have at least one additional film taken
during the year. The usual methods of treatment have been continued in the Dispensary.
Five City and 19 non-City cases of pulmonary tuberculosis attended for the continuation
of their treatment by artificial pneumothorax. Collapse therapy, by means of Artificial
Pneumothorax intra and extra pleural, Thoracoplasty and Phrenic interruption have been
used on an increasing scale.
(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. (No patient was so provided during 1938.)
(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 £30 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 sub,
committee 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.
Screening.—A floroscopic screening examination is made on every patient prior to
the Artificial Pneumothorax refills.
Until recently the method used in dealing with adult "contacts" of cases of pulmonary
tuberculosis 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
† The present lady members of the Committee are Miss Crosby, M.D.E. (Vacant).