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46
Bacteriological Diagnosis of Consumption.—The number of specimens of
expectoration sent by medical men for bacteriological examination, from cases in
which there was some doubt as to the diagnosis, was 426 as against 440 in 1920. Of
these, 83 were found to contain the bacillus of consumption, while the remainder
were free.
Non-Pultnonarv Tuberculosis.—The great bulk of the total notifications—37
as against 44 in 1920—in the case of this form of tuberculosis came from institutions
where the patients were undergoing treatment. Visits were paid to the homes and,
where necessary, advice with regard to the obtaining of treatment was offered.
Particulars as to the parts affected by the disease will be found in the table on
page 50.
The following short note by the Tuberculosis Officer (Dr. Saner) contains
reference to a number of points that' may be of interest. It relates to the period
following the taking over of the Dispensary and its incorporation with the Public
Health Department.
" So far the Dispensary Premises have been adequate to cope with the number
of patients attending. Under the voluntary system many more patients were kept
under observation, but now these suspect cases are examined and according to their
condition requested to attend in 1, 2, or 3 months as the case may be for further
consultation. This arrangement works satisfactorily and accounts for the drop in the
number of attendances recorded in past years.
The main figures for the year are embodied in the Report of the Medical Officer
of Health ; it may be noted, however, that during the year about 128 patients have
received Institutional treatment through the London County Council, the Invalid
Children's Aid Association or the Guardians.
A certain number of advanced cases remain in their homes chiefly because they
refuse to take advantage of the St. Marylebone Hospital, the only Institution to which
patients in this stage of the disease are readily admitted. The nursing of those who
remain at home is undertaken by the District Nursing Association under the supervision
of Miss Marsters.
Perhaps the most difficult part of the problem of prevention of tuberculosis lies
in relation to the advanced case. As a rule it is impossible to isolate the patient from
the rest of the family, especially during sleeping hours, owing to the lack of room
and beds and all that can be done in addition to providing nursing is to give advice
and instructions, and to visit periodically to see that the instructions are being
carried out as fully as possible.
The Care Committee meets fortnightly to consider the cases for treatment at
Institutions and to assess the amount of payment required, which as a rule is
according to income. Necessitous cases are also dealt with and referred to the
Charity Organization Society, or the Guardians for assistance. The Charity
Organization Society also assist patients returning from Sanatorium to obtain suitable
employment.
So far as regards the occupation of patients attending the Dispensary it may be
noted that whereas most of the ordinary trades are represented, except in the cases of
porters (8), clerks (7), and labourers (5) on the male side, housewives (11) and
domestic servants (10) on the female, there appears to be no particular involvement
of any class of employment.
Among children definitely affected there were 3 boys and 5 girls. It is difficult
to explain why housewives and servants should predominate, though it is notorious
that during the War there was a very definite increase in the number of cases
amongst women. The importance of the fact in relation to spread of infection is
obvious."