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75
(b) REPORT BY DR. C. K. CULLEN, TUBERCULOSIS OFFICER
Although during the year the number of new cases of tuberculosis notified
in the borough fell almost to the low level of 1936 the dispensary figures do not
fully reflect this drop as in recent years the proportion of new cases coming under
direct dispensary supervision has been increasing. Apart from patients already
resident in some institution for the mentally or physically infirm, practically all
new cases are now referred or come of their own accord to the dispensary either
before or after sanatorium treatment and are kept under supervision on the conclusion
of this treatment.
There are still however a large number of patients on the borough tuberculosis
register, in most cases notified many years ago, who, although known to the
tuberculosis visitors, cannot be regarded as being under dispensary supervision
as they will not attend the dispensary ; and although many of these may no longer
be suffering from active disease their names cannot be removed from the register
until medical examination and a satisfactory history of good health during the past
five years have confirmed the arrest of the disease. A partial revision of the register
was made in the early part of the year with the assistance of a temporary additional
visitor who was employed for a month on this work. Approximately 300 names
were taken off mainly on the ground of removal to unknown addresses or to other
boroughs, in addition to those taken off in the normal course of dispensary work.
There still remains on the register a large number of old cases whose condition
can only be reviewed when the normal dispensary work permits of special efforts
being made to secure their attendance and examination.
There has been a continued drop in the attendance of contacts for examination.
This is only partially accounted for by the drop in notifications and I have been
unable to discover any other contributory cause. There has always been some
difficulty in persuading some of the young adult contacts to attend and sometimes
a suspected case in the family refuses to come through fear of tuberculosis being
discovered. These two classes of contacts are of course precisely those whom we
most want to examine.
The number of children attending the special clinics for school children has
also declined somewhat but there has been a growing tendency for children to be
brought to the ordinary clinics.
There has been a very welcome speeding up of rehousing of tuberculous families
through the London County Council, with an increase in the number of families
rehoused and a shortening of the waiting period in the majority of the cases.
Incidentally this has involved a marked increase in the correspondence and clerical
work in the dispensary. The growth in the volume of clerical and internal
administrative work from this and other causes in the past few years has necessarily
curtailed the number of visits paid by the tuberculosis officer to patients in their
homes ; and whilst it is not one of the functions of the dispensary to provide home