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34
Class of Tuberculosis Admitted.
All the Boroughs accept notifications which are based on clinical signs
and symptoms; four occasionally obtained bacteriological confirmation, but
do not insist upon this as an essential preliminary to notification.
This waiving of confirmation by microscopic methods is wise, seeing
that in the early stages of a large majority of cases, it is most difficult to
obtain, and often, only after frequent and repeated examinations of the
sputum. At present all the Boroughs restrict notification to pulmonary tuberculosis,
which is comparable to only accepting notifications of Diphtheria,
which relate to the Larynx, allowing cases affecting the nose or Pharynx to
run riot.
It would be better to accept notifications of Tubercle irrespective of the
site of the disease, but with the proviso, that in the case of discharging
abscesses and sinuses, bacteriological confirmation should be forthcoming.
Notice of Disinfection.
Six Boroughs send no notices, but four do.
In two, an Inspector calls and offers disinfection; in one, the consumptive
room is fumigated weekly, and the bedding occasionally steamed.
In one (Stoke Newington) the authorities are almost invariably asked to
disinfect after death.
In Woolwich, a notice of disinfection is accompanied by the special card
of instruction.
It would be best in my opinion to offer disinfection on death or removal,
and to let an Inspector call, rather than send formal notice.
Inclusion of Public Institutions.
All the Boroughs include Public Institutions as sources of notification.
The wisdom of this course will be appreciated when it is known that
numberless cases of Phthisis never come under medical treatment at all, until
they are almost moribund. This especially is the case with the very poor,
the homeless and unemployed.