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59
In addition to these consultations a very considerable number
of cases was sent to the Dispensary by general practitioners for
diagnosis. After each such examination is made a letter is cent
to the doctor and a copy filed with the case sheet. During 1921
the number of such letters was 433.
Means of Diagnosis.
The diagnosis of tuberculosis is in many instances a matter of
extreme difficulty. The use of tuberculin as a diagnostic aid has
been practically given up as its value appears to be doubtful, e.g.,
two suspicious cases during 1920 were tested by tuberculin up to
.01 inj. Tuberculin. No focal or general reaction resulted in these
cases, and on that basis the opinion was justified that the cases
were non-tubercular. During the present year the sputa of these
two oases have both been found to be positive, and the sounds in
the chests were such as to indicate fairly long-standing tuberculosis.
The need of some beds for diagnostic purposes is very keenly
felt. This in most large towns is an integral part of the tuberculosis
scheme, but it has not so far been found possible to provide
these with the limited accommodation available in Croydon.
Also the need of X-Ray Apparatus in the Department is very
definitely felt; the value of X-Ray examination of the chest for the
purpose of diagnosis is very great and it has only been possible,
owing to the expense of such work, to have a small number of
such examinations made each year. In 1920 12 such examinations
were made and in 1921 34.
The provision of an X-Ray apparatus in the Department itself
would not only provide such means of diagnosis, but would enable
the treatment of ringworm in school children to be carried out by
our own staff.
Dispensary Records.
During the past two years the mode of record of the cases has
been altered from the card and book system to the dossier system
so that now every case has its record complete and is immediately
available in itself. This has entailed a very large amount of extra
work which has been carried out principally by the Health Visitor
actually attached to the Dispensary. The whole work of the
dispensary has been very greatly facilitated by this change.
Shelters.
Sixteen shelters are in use throughout the Borough. They
are practically all used for cases which have had sanatorium treatment;
they are periodically inspected by the Tuberculosis Officer
and the Health Visitors. The shelters are much appreciated by the
patients using them.