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If this stage of quiescence is maintained without relapse for two consecutive years, the
patient is " arrested ", and if remaining so for three years the name can be removed from the
registers as recovered.
In addition to notified cases, there are, of course, many persons, adult and child, who are
under observation as suspects or as contacts.
During this period frequent examinations and tests are made, and X-rays are carried out
under arrangements made between the Borough Council and Brompton Hospital.
The great importance of X-rays as an adjunct to dispensary work is nowadays universally
recognised. All doubtful cases require radiography, and as many others as possible, because it is
sometimes very difficult to assess the amount of damage done to a lung by purely external means,
or to be certain that no fresh deposits of disease are being formed.
In previous annual reports mention has been made of Mantoux tuberculin tests carried out
on children and it will be remembered that a positive reaction does not necessarily imply that
disease was present, but that infection with the micro-organism has at some toccurred, giving rise to tuberculin sensitiveness.
Conversely, however, the absence of such a reaction would demonstrate (in the great
majority of cases) that no infection had taken place and, therefore, there could not be disease
present—a very important fact from the diagnostic standpoint in an otherwise suspicious case.
Mention has already been made of the co-operation with medical practitioners, with whom constant
touch is kept concerning their patients: but the Dispensary is equally in touch with other Health
Services, the School Medical Service and with the Public Assistance Committee and hospitals.
Treatment.
Sanatorium is still the best basic form of treatment for tuberculosis—the complete rest,
fresh air, feeding and hygiene having a natural tendency for the promotion of healing. When
the toxaemia has thus been overcome, graduated exercises stabilize the condition and help to
render patients as fit as can be expected to return home and carry on.
It should be pointed out that patients have to be selected for sanatorium treatment—which
would not be suitable for all, either from the point of view that the disease might be too
advanced and a stay in sanatorium only filling an otherwise useful bed to no advantage; or the
age of the patient might militate against such open-air treatment especially in winter time, or
if complicated by much bronchitis.
I here are other forms of treatment which are often used in combination with sanatorium.
•va) Surgical measures, all designed to give rest tc the damaged lung, such as artificial pneumothorax
and refills, phrenic evulsions and more rarely thoracoplasty. (b) Injections of gold salts
and tuberculins, (c) Heliotherapy, in the form especially of ultra-violet rays and Finsen Light.
All these forms of treatment are arranged through the Dispensary, the cost of special
treatment being borne by the Borough Council whilst provision of sanatorium treatment under the
L.C.C. is free.
I he Elizabethan Open Air School (L.C.C.) caters for f>0 children, who are notified for gland,
at Nominal and other forms of non-infective tuberculosis, and who are in a state of quiescence or
arrest.