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91
Report by Dr. C. K. Cullen, Tuberculosis Officer.
The facilities provided by the Tuberculosis Dispensary and the changes
in procedure and origanization consequent upon the opening of the new
dispensary at Great Cambridge Street were fully described in last year's
report.
A few comments on the Dispensary statistics may be of interest. There
has been a heavy drop in the new attendances during the year 1932, but a
third of this drop was accounted for by the figures for December alone when,
possibly owing to the very mild weather in that month, only fourteen new
cases attended for examination compared with fifty-five in the previous year.
Co-incident with the drop in new attendances, there has been a marked decrease
in the number of new notifications during the year. Unfortunately
this does not necessarily indicate a steady decrease in the incidence of
tuberculosis, as the figures for the first quarter of 1933 show an increase of
33 per cent, in the new notifications compared with the same quarter of 1932.
There is another factor which may possibly be partly responsible for the
apparent decline in 1932. During the year practitioners have shown an
increasing tendency to refer suspicious cases to the Dispensary before notification.
There are a number of chest conditions which closely simulate
tuberculosis and the more detailed investigation which is possible at the
Dispensary has excluded the disease in many cases which might otherwise
have been notified. A lesser factor, but one which undoubtedly exists in
these times of widespread unemployment, has been the fact frequently stated
by patients that they are often reluctant to attend for fear of being advised
to go away to sanatorium and possibly lose their employment. When, as is
often the case, the patient is the only member of the family at work and the
only alternative means of livelihood is through relief by the Public Assistance
Committee, there is even greater reason for this reluctance. Every
effort is made to meet this difficulty and whenever the patient is willing a
letter is sent to the employer urging him to promise re-employment when the
patient is fit to return to work without danger to himself or others. In many
cases these letters have been effective.
Corresponding to the decrease in new cases investigated, there has been
a heavy drop also in the total attendances. This again may be partly due
to the fact that with a smaller number of patients sent up it has been possible
to give more detailed attention to each patient and thus arrive at a definite
diagnosis more quickly and with fewer visits to the Dispensary. In this
connection, I would point out that there has been a much higher proportion
of examinations. Greater use has also been made of X-ray facilities and the
number of sputum tests has again shown a considerable rise.
In spite of the fewer attendances, it is generally agreed by the whole
Dispensary staff that the work of the past year has been heavier. Increasing
economic difficulties present problems which are almost insoluble under
present conditions, but which involve a great deal of time and anxiety in the
attempt to find some solution.