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in April, 1921. The Dispensaries have since been utilised, more for preventive,
rather than for curative, treatment. For this object, the members of the
families of patients who have been exposed to infection have been examined
by the Tuberculosis Officers at the earliest opportunity, and steps taken to
effect a cure in those who show early symptoms of the disease.
The examination of "contacts" has been more satisfactory during the
last four years. It has been found possible to arrange for a much larger percentage
to be examined. An arrangement has been in practice during the last
four years with the L.C.C. School Medical Officers, which ensures that no
"contact" of school age will remain unexamined. If the Dispensaries are
unable to arrange an examination, the School Medical Officers are notified,
and the examination is carried out at school. The result of the examination
is communicated to the School Medical Officers, and reciprocal reports are
exchanged as appears necessary.
The desirability of routine "contact" examination has, on a number of
occasions, been proved by the discovery of advanced and very infective cases,
which have evidently disseminated infection to the other members of the family
for years past. They have remained undiscovered and untreated until routine
"contact" examination has revealed the source of infection. It is these
"unknown" cases which are particularly likely to spread infection, owing
to the fact, that they take no precautions against infecting others.
It is more difficult to persuade adults, particularly men, to be examined
than other "contacts," although the value of early diagnosis is becoming
better known, and a larger percentage of adult "contacts" are being examined
every year.
A large proportion of the people suffering from Tuberculosis are still not
notified, and we only discover them when their deaths are registered. There
has been an improvement during the last five years. In 1921, 43 per cent. of
the persons dying from Phthisis had not been notified during lifetime and,
in addition, 5 per cent. were notified only at the time that the deaths were
registered. In 1925, 20 per cent. only of the total deaths from Phthisis were
not notified during lifetime, and 8 per cent. at death. The usefulness of the
Dispensaries is severely handicapped, through the remissness on the part of
medical men, in not notifying persons suffering from Phthisis, immediately
they have made up their minds as to the diagnosis. It is true that some of
the deaths occurred in Mental Hospitals, and no useful purpose would be
gained by having them notified. These cases, however, form a very small
proportion of the total, and most of them are notified during lifetime. The
majority of the unnotified cases are those whose deaths occur at their own
homes, and at the Poor Law Hospitals.