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39
Tottenham and Wood Green Chest Clinic
Dr. T.A.C. McQuiston makes the following comments on trends in the incidence of tuberculosis
and the work of the Chest Clinic during 1960.
The number of new notified cases does not change appreciably despite the very considerable
fall in the death rate. The other notable feature is the preponderance of morbidity and mortality
in the older age groups, particularly in males.
The apparent high number of patients on the tuberculosis register is easily explained.
According to the Ministry of Health classification, patients' names may be removed from the
register after a period of five years' quiescence. In certain cases, even though this stage has
been reached (Ministry classification "Recovered"), we may still retain their names on the register
forvarious reasons which may be associated with the type of their work or their social conditions.
This procedure means that a stricter check is still kept on their clinic attendance since, when
their names are removed from the register as recovered, certain patients may be less likely to
keep up regular yearly or half-yearly checks-a practice we try to encourage in every case for an
indefinite period. The total number of attendances at the chest clinic per annum is, therefore,
fairly constance and certainly the amount of work we have to do has not diminished in recent
years. The number of miniature films requested by private doctors has increased this year2,205
films in 1959 and 2,859 in 1960.
A considerable problem is presented by patients with chronic bronchitis and emphysema,
generally middle-aged and elderly males. From this point of view we find it is a great advantage
having beds available to the chest unit, particularly in the winter months, when we can admit
them promptly for treatment of an acute respiratory infection or for cor pulmonale. Such conditions
in those with very restricted respiratory function may prove rapidlyfatal if not dealtwith promptly.
Most of such cases are probably known to us at the chest clinic since they are likely to have
attended at some time or to be already under our constant supervision.
I feel that the matter of notifying all tuberculous conditions should be emphasized to
practitioners and general hospitals so that the chest clinic is in a position to check all contacts
and to see that adequate supervision of such cases is carried out. It quite frequently happens that
a patient may have been treated in a general hospital for months before we ever get to hear about
it and much consternation is caused amongst contacts when we begin to follow them up at that
late stage.
Attendances
Total attendances during 1960 21,121
Total of new cases sent for diagnosis by G.Ps in 1960 5,085
Those of above total notified as T.B. 100
" " " " having full examination 2,226
" " " " having miniature X-ray only 2,859
Total number of new contacts seen in 1960 946
Those of above found to be tuberculous 15