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120
In that Annual Report, and in my Annual Report for 1953, I included
reports by Dr. Emslie on her work ; and the following is an extract from the
former of these two reports:—
"In my opinion there are great advantages in having this work done at our
Infant Welfare and School Clinics. The children are accustomed to come there,
where they feel quite at home, and the Health Visitor and the Doctor are generally
known to them already. On the other hand, at the Chest Clinic there is only one
session a week at which children can attend, and this would make it very difficult
to read tuberculin tests there. If, however, appointments were to be given for
children to attend the adult sessions at the Chest Clinic, they would be exposed
to a risk of infection there ; but, on the other hand, primary tuberculosis in
children is not infectious to others. Again, the necessary follow-up of cases is
much easier to arrange at our own Welfare Clinics.
"Preliminary tuberculin testing is done at all ordinary sessions at Dawlish
Road Clinic, and no special session is set aside for that purpose. The actual
B.C.G. vaccination must be done on one particular day for each batch of vaccine,
which must be fresh; but it is done by appointment during or after the School
Clinic session.
"Adults with tuberculosis have to be given special accommodation apart
from others because of the danger of infection, but in the case of children separate
accommodation is not necessary. By encouraging the attendance of children
at Local Health Authority Clinics we are helping to show that tuberculosis is
is not due to malignant fate, but is a preventable infectious disease in the same
category as diphtheria and whooping cough.
"It is well known that infants and young children are very susceptible to
tuberculous infection, and a Local Health Authority should be in a position to
offer immediate protection by B.C.G. vaccination whenever we learn that children
are exposed to infection.
"Dr. Emslie has shown that the work can be undertaken satisfactorily in a
Local Health Services Clinic, and has given reasons why it should be done there
rather than at a Chest Clinic.
"All the evidence at our disposal is to the effect that B.C.G. vaccination is a
valuable preventive measure, and the prevention of tuberculosis is not only
better, but infinitely less expensive, than its cure."
It will be seen from the following report by Dr. Emslie, on B.C.G.
Vaccination during 1954, that this work—which she is so well qualified, and
so keen, to undertake—has now been undertaken by the new Chest Physician.
After all the trouble taken to obtain Ministry of Health approval for Dr.
Emslie to carry out this work, it is unfortunate that mothers and children
should be "switched about" from one to another of the two public authorities
who are each dealing with the same problem (Tuberculosis) in different
ways. In 1952 I reported:—
"Before 1948 the prevention of tuberculosis was regarded as being more
important than its cure, and all the work connected with prevention and treatment
(domiciliary and institutional) was under the control of the Local Health
Authority. Since 1948 the Regional Hospital Boards have been responsible
for the staff and the work undertaken in Chest Clinics, and for all treatment
either at home or in hospital; whereas the Local Health Authorities have been
responsible for the appointment and work of the tuberculosis health visitors.
Such dichotomy of effort has given rise to administrative difficulty of the type
inherent in any scheme which is subject to dual control.
"Owing to the lack of essential medical equipment and facilities at Leyton
Chest Clinic, Leyton patients are subjected to unnecessary inconvenience, delay
and expense by having to attend at the various institutions to which the work of
the Leyton Clinic has been farmed-out; and the supervision of contacts is
therefore more difficult than it should be."
Unfortunately the dual control, and the associated dichotomy of effort,
are still with us; but for those imbued with faith in things to come there
should be consolation in the assurance that there is somewhere in existence
"a long-term plan" for the co¬ordination of chest clinic facilities in Leyton
with those of a neighbouring area.