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health visitors or school nurse to 507 cases, a total of 530 visits and
revisits being paid.
Notification of casts of Tuberculosis by medical practitioners
were usually prompt. A certain proportion of the notifications referred
to persons in whom the disease was advanced, but it must be remem
bered that in many cases the disease takes a rapid course and is often
well developed before the patient comes under medical treatment. In
fifteen instances the first intimation of a case was the notice of admission
to a sanatorium or other institution. These were principally men
who were soldiers discharged from the service on account of tubercular
disease and sent to sanatoria soon after they had received their discharge
from the army. In some instances the previous residential connection
with Twickenham was of a very slender character.
The Medical Officer of Health has again continued to act as
Deputy Tuberculosis Officer for this area of the County of Middlesex
during the year, and in consequence the co-operation between the
County Council as the Tuberculosis Authority and the Local Health
Authority has been complete.
The School Medical Officer has examined a considerable number
of the contacts who were of school age. Visits of enquiry and
disinfections after death or removal have been continued as usual.
Cerebro-Spinal Fever.—Four cases of cerebro-spinal Meningitis
came under notice in the district during the year, and all proved
fatal. Three of these were removed to the hospital for observation and
treatment. One was a naval case home on leave. The home contacts
examined were found free from the organism causing the disease, which
presumably was contracted in the service. The second case was that of
a young woman in one of the large temporary Government departments.
In this case, one of the contacts, a Canadian soldier was found to be a
carrier of the disease. In the third case, removal to hospital was not
requested and the diagnosis was not confirmed baeteriologically. In
the fourth case, two of the contacts were found to be carriers of the
disease, and examination was repeated during six to eight weeks before
the absence of causative organism could be reported. No further case
erose from this source.