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Group 3.—Cases with profound systemic disturbance or constitutional
deterioration, with marked impairment of function, either local or general,
and with little or no prospect of recovery.
All cases with grave complications (e.g., diabetes, tuberculosis of intestine,
etc.), whether those complications are tuberculous or not, should be
classified in this group.
Group 2.—All cases which cannot be placed in Groups 1 and 3.
IV.—Patients suffering from non-pulmonary tuberculosis should be
classified according to the site of the lesion as follows:—
(1) Tuberculosis of bones and joints.
(2) Abdominal tuberculosis (i.e. tuberculosis of peritoneum, intestines
or mesenteric glands).
(3) Tuberculosis of other organs.
(4) Tuberculosis of peripheral glands.
Patients suffering from multiple lesions should be classified in one subgroup
only, viz., in that applicable to the case which stands highest in the
immediately preceding list.
Report by Dr. C. K. Cullen, Tuberculosis Officer.
As will be seen from the figures given in the statistical section of this
report, there has been a marked increase in almost every aspect of the Dispensary
work. New patients examined show an increase of 20%, new cases
notified in the Borough 26%, total attendances 16%, examinations 16%,
contacts examined 27%, and cases receiving extra nourishment 41%. The
increase in the number of attendances of non-insured patients, which this
year exceeds the number of insured, is an indication that a growing number
of patients are lapsing from the benefits of health insurance. These figures
suggest that unemployment and its associated poverty are taking an increasingly
heavy toll on the lives of the people of Shoreditch.
Yet the full extent of the increase in the Dispensary work is not revealed
by the figures. As I indicated in my report last year, the attempt—often
fruitless—to find some solution of the economic difficulties of the patients in
order to enable them to benefit from treatment and supervision involves the
expenditure of a considerable amount of time and anxiety in almost every
case; and a large proportion of the time of the Tuberculosis Officer, the Care
Committee Secretary, the Health Visitors, and the Clerk is spent not in
dealing with the medical aspects of tuberculosis but with the social problems
affecting the individual. It is a serious reflection on our present social
organization that, in an age when the development of industrial science and
invention has placed within our reach vast possibilities of wealth production,
widespread poverty should largely nullify our efforts in the treatment and
prevention of disease.