Improving the identification rate of pulmonary tuberculosis among inmates of common lodging houses.

SUMMARY An improvement in the identification of pulmonary tuberculosis among residents of common lodging houses has proved possible through the close cooperation of the doctor providing primary medical care, the mass miniature radiography services, and the wardens of the hostel where the proposed visit is to take place. Renewed interest has recently been expressed about the single homeless and their place of residence-the common lodging house.12 Although the population appears to be on the increase, and is mainly confined to the inner city areas, it is by no means a new phenomenon.3-5 The common lodging house developed in the nineteenth century, and its character has changed little over the years. The residents are mainly of Celtic or Northern origins, usually men, single, homeless, suffering from personality disorders, and socially isolated, with a high incidence of chronic alcoholism.8-" The homeless form a particularly morbid subgroup29 12 13 Half of the habituees of common lodging houses in Edinburgh12 had some form of chronic disease. Moreover, this population represents a reservoir of infection, particularly of tuberculosis, such that it could be considered a health risk to the whole community. Referrals to the chest clinics were eight times higher13 than the normal population, and 10% suffered from tuberculosis. In Glasgow tuberculosis was found to be the fourth most common cause of death among the lodgers in the common lodging house, and the average length of survival after diagnosis was three years.14 One report15 suggests that the streets in the immediate vicinity of a large common lodging house have a high incidence of tuberculosis. The Joint Tuberculosis Council reported in 196516 on the x-ray results of 488 residents from lodging houses at 12 cooperating centres in England, suggesting that this population had a twentyfold increased incidence of tuberculosis. Previous attempts at locating and diagnosing such reservoirs of tuberculosis were based on surveys of common lodging houses by the mass miniature radiography services. Their success will depend on how many inhabitants accept radiography. Experience has shown a poor response. In Glasgow 860 residents of common lodging houses were invited for MMR."7 Only 193 (22%) were x-rayed, of whom 67 were referred to a chest clinic. Of these, 56 attended and 22 were found to have pulmonary tuberculosis. In Edinburgh, from 1967 to 1971, the visiting MMR managed to x-ray only 18% of the residents in the common lodging houses."8 The study NJS has been providing primary …