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Dr. Philip Ellman, Consultant Physician to the Chest Clinic,
reports on the work of the Clinic, as follows:-
The nature of the report this year has necessarily had to be
curtailed and it is therefore proposed to comment principally on
features of tho work which have a war-time significance, and to
express certain personal views thereon.
The figures under the separate headings, such as "Attendances"
"Medical Examinations" "X-Ray Examinations", etc. are self-explanatory
and require no special comments except to add that, despite
some curtailments in the first few months of the war, the work has
been well maintained.
Close co-operation with Harts Sanatorium, Thoracic Surgical
Units and General Hospitals continues' to be well maintained.
THE EXAMINATION OF RECRUITS.
An important feature of our work since tho war has been the
large number of recruits referred to us by the Medical Boards for a
consultant opinion, where any diseo.se of the chest is suspected.All
these cases have been subjected to routine clinical, X-ray and
bacteriological investigations. Only in a small percentage of these
cases has lung tuberculosis boon detected.
THE NUTRITIONAL PROBLEM IN TUBERCULOSIS IN WAR TIME.
The nutritional .aspect of pulmonary tuberculosis has been
emphasised in previous reports. It is indeed unfortunate that under
the National Scheme of Rationing tho tuberculous patient is for tho
most part left without any special dietary provision. The Special
Pood Rationing Advisory Committee appointed by tho Minister of Food
to investigate the diet of patients suffering from various diseases,
has advised him that, provided there is an increased consumption of
milk, cheese and eggs, tuberculous patients need not suffer from
lack of "first class" protein. Hence no extra ration of meat was
advised. Repeated cheese dishes are likely to bo monotonous and
therefore not stimulating for the often impaired appetite of tho
tuberculous subject; whilst free and cheap milk is limited to
nursing mothers and children under five.
NEED FOR FREE AND CHEAP MILK FOR TUBERCULOUS PATIENTS.
Surely the tuberculous patient whose means are limited, is
entitled to this too in addition to those who come under the extra
nourishment category of local authorities. Our experience since the
beginning of the war has shown that tho need for a full supply of
cheap milk for tho tuberculous population of the Borough is
eminently desirable, and in many cases, a crying need.
MASS X-RAY EXAMINATION OF THE CHEST IN RELATION TO EARLY
DIAGNOSIS IN RECRUITS AND INDUSTRY.
It is generally accepted that under present conditions not
more than 5% of cases are diagnosed in that stage of the disease
when the lesion is minimal, curable, and essentially suitable for
treatment at a sanatorium. The result is that our sanatoria are
often crowded with cases which wo cannot hope to cure and which
are a constant strain on the financial sources of the community.
How are we to get early minimal curable cases to fill our
sanatoria? The war has brought to light the value of mass X-ray
examinations of the chest by a recent development in technique as a
possible practical solution. The recent recommendations of the
Horder Committee support the value of mass X-ray examinations of
tho chest in tho early detection of tuberculosis in recruits. The
available methods for such examinations are, as follows:-
26.