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18
TUBERCULOSIS OFFICER'S REPORT
Since the last normal Report in 1938, many changes have occurred in the
tuberculosis world as in other fields of medicine, and more changes are in prospect.
There have been important developments in diagnosis, in treatment, and in the
attention given to the social and economic welfare of the tuberculous patient and his
family.
The introduction of mass miniature radiography has made possible the X-ray
examination of large numbers of apparently normal poeple aggregated together in
factories, schools and hostels, with a very great saving in time and materials. Because
of the present limitations, however, the travelling mass radiography unit operated
by the London County Council has only been able to visit the neighbourhood of
Shoreditch twice since its inception in 1943. On each occasion the unit was stationed
in a neighbouring borough for a few weeks and Shoreditch was given the opportunity
to send only two thousand workers from local factories for examination, a very small
proportion of the day-time working population. Attendance was, of course, voluntary.
These limited facilities can hardly be regarded as being more than experimental.
Apart from mass radiography, far more use has been made of the ordinary full-size
film technique. All patients referred to the dispensary for investigation are now
X-rayed as a routine, periodical examinations are made of most adolescent " contacts"
and serial check-up films are taken of patients under supervision to assess the progress
of treatment. In 1938, the number of X-ray examinations for the dispensary was
392; in 1947 the number had risen to 1,067.
Another diagnostic test much more extensively used in recent years is the
tuberculin skin test, mainly for children. The method used at the Shoreditch
Dispensary is almost invariably the tuberculin jelly test, carried out as a routine on
all children attending as suspects for diagnosis or for examination as contacts.
Children with positive reactions are X-rayed as a routine ; those with negative
reactions are only X-rayed if some abnormal condition is suspected.
In the field of treatment, far more use is now made of thoracic surgery and
there has also been a steady increase in the number of cases treated by artificial
pneumothorax. Arrangements were made with the neighbouring Chest Hospitals
to undertake this work; and though the volume of both radiographic examinations
and pneumothorax treatment has very considerably increased, the restricted accommodation
at the dispensary precluded the installation of X-ray apparatus or the
holding of pneumothorax clinics. The arrangements with the Chest Hospitals for
pneumothorax refills have therefore been continued, and 33 patients received a total
of 541 refills.
Since 1936, when the County Council offered facilities for X-ray work at their
own hospitals, the bulk of the radiography has been done at St. Leonard's Hospital
and the radiological interpretation of the films at the dispensary. For working
patients unable to attend that hospital during normal week-day hours, facilities have
been available at Bethnal Green Hospital on Saturday afternoons. A few requiring