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46
about the condition of the premises, following which the sanitary inspector
visits those houses where housing is unsatisfactory, either because of
crowding or because of the structural state of the premises.
S. 172 of the Public Health Act, 1936, empowers steps to be taken
compulsorily to remove to hospital on a court order an infectious person
suffering from pulmonary tuberculosis where precautions to prevent the
spread of infection cannot be or are not being taken. As there are so
many sufferers anxious to be admitted to hospital for treatment who
cannot, without long periods of waiting, be accepted, it would these days
have to be a very glaring case in which the person would have to be felt
to be really a danger that would justify the use of these powers. In point
of fact no application for such a court order has yet been made in this
district.
Other preventive measures are taken by the County Council as the
Local Health Authority under the powers of S. 28 of the National Health
Service Act. This work is based on the local chest clinics and is carried
out by persons who are on the staff of the County Council either full-time
or part-time; those engaged on a part-time basis working for the rest of
their time for the Regional Hospital Board. The preventive measures include
close supervision of the contacts of declared cases, the boarding out
of susceptible infants and children with relatives or other suitable foster
parents, health education and propaganda. Supervision of the purity
and safety of milk supplies is another preventive measure. Employment
schemes and contact between the chest physicians and the local
officers of the Ministry of Labour and employers are also of help.
The examination of persons by mass miniature radiography plays its
part in the early detection of disease. It is especially helpful when normal
persons are examined—that is, those who do not suspect that they are
otherwise than quite well and so would not in the ordinary way attend
their doctors. Examination of such healthy groups leads to the recognition
of the disease often in its early and therefore most readily curable
stage. Work on these lines is limited by the number of appliances and by
the numbers of persons trained in this work. It is necessary, then, to
select for examination those groups who are most likely to give results.
At present it is not profitable to attempt to undertake the examination of
the entire population, and it is very doubtful if the results would ever
warrant this procedure. Instead, attention is concentrated on those
sections of the population which probably contain the highest proportion
of sufferers. For this reason certain age groups and more especially those
of these ages working at certain types of work are those whom it is
most profitable to examine. Although it might be worth while carrying
out the examination of school child contacts of a declared and recognised
case, in general there is little point in examining children of school age as
a routine practice. When in due course the school-leaving age is raised
to 16 it might be worth while examining school-leavers as a routine.
Today it is probably sufficient to encourage those of 15 or over attending
school to attend the public sessions when the radiography unit visits the
district. Although the unit is essentially part of the preventive service
in that its purpose is the early detection of the disease, it is provided and
administered as part of the hospital or essentially treatment service.