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The Chest Clinic with the physician-in-charge is the focal point. The physician is employed by the
Regional Hospital Board and is a consultant in diseases of the chest. Although primarily a clinician concerned
with diagnosis and treatment, he is fully aware that the prevention of the disease on the one hand and the after
care of patients on the other cannot be divorced from treatment. For this reason the physician at the Clinic is
responsible for the general supervision of the local authority's scheme to promote the after-care of patients.
Experience has shown that this arrangement works smoothly and is effective. To promote this, the Council's
staff employed at the Clinic come under the direct control of the physician for the day-to-day administration of
all routine duties relating to the management and after-care of patients.
Home Visiting
There were four tuberculosis' visitors on the staff at the end of the year. In addition to home visiting,
they undertake duties at the Chest Clinic and act as clinic sisters at diagnostic and treatment sessions. During
the year they made 1,229 visits to patients' homes. The tuberculosis visitors advise on the prevention of the
spread of infection, on arrangements for care and after-care, and keep all known contacts under close supervision.
Included in the above figure of 1,229 visits are those made to non-tuberculosis households when 251
such visits were made.
Welfare
The decline in the incidence of tuberculosis has had a marked effect on the functions and duties of
welfare officers attached to Chest Clinics.
To a growing extent, more and more patients suffering from non-tuberculosis chest diseases, such as
chronic bronchitis and lung cancer, are being seen by the physician, and are being referred to the welfare officer
whose duties have become more comparable to the general type of medical social work undertaken by medical
social workers in hospitals. The medical social work undertaken at the Chest Clinic is now integrated with that
of the hospital service. It should be emphasised that this has not led to any loss by tubercular patients of the
benefits they may receive from the authority's arrangements for their care and after care. Rehabilitation
through full-time training is provided by the Ministry of Labour at their training centres.
Occupational Therapy
This is the first stage in the rehabilitation of the patient. Guidance and training in a wide range of
handicrafts is given to selected patients in their own homes; classes are also held at the Willesden Chest
Clinic. Until 31st March, 1967, the occupational therapist, in addition to providing a service to patients in
Brent, served patients in the London Boroughs of Ealing, Hillingdon and Hounslow. On 31st March, Hillingdon
terminated the arrangement and the 25 per cent of the occupational therapist's time which was spent serving
patients in that Borough was allocated to the Welfare Division of Brent. The occupational therapist also visits
patients in the Hostel for Homeless Tuberculosis men at Twickenham. There is an appropriate financial
arrangement with these authorities.
Two hundred and fifty-eight successful visits were made to patients' homes in Brent. There were 185
attendances at Willesden Chest Clinic classes.
Vaccination against Tuberculosis
The scheme provides for the vaccination with B.C.G. of individuals who are contacts of tuberculosis;
school children aged 13 and over; students attending universities, teachers' training colleges, technical colleges
or other establishments for further education.
The number of persons vaccinated during the year was 2,615.
For details of tuberculin testing of school children and school leavers, and B.C.G. vaccination of
school leavers, see report of Principal School Medical Officer, page 67.
VENEREAL DISEASE
Since the operation of the National Health Service Act, 1946, responsibility for the treatment of
venereal disease has rested with the Regional Hospital Boards.
The Council, however, continue to be concerned in co-operating with the work of the venereal disease
treatment clinics as regards following up persons under treatment or known or believed to be sources of infection.
In this connection, the Council's Medical Social Worker attended venereal disease clinics at the Central
Middlesex Hospital and her services were utilised for the purpose of tracing contacts and following
up defaulters, as well as assisting patients attending the clinics in meeting any social problems with which they
were faced.
It is impossible, in the absence of compulsory notification, to form any estimate of the real incidence of
venereal disease in the community, particularly since modern methods of antibiotic treatment and
chemotherapy can be undertaken by experienced general practitioners. No information as to numbers treated
by general practitioners is available.