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60
I hope by means of the proposed extra services and redistribution
of the nurse's work that the stress will be less, and I think that by a
judicious reference of suitable cases for observation at the schools, as
suggested by the London County Council, that the number of total
attendances, and also the drug bill, may be reduced. More time will
be left therefore for the examination of new cases and contacts.
The proposal mentioned above is as follows:—Children who are
doubtfully positive and in delicate health shall be referred for periodic
examination by the school doctor, and, if necessary, milk supplied at
school; if their progress is not satisfactory they will be referred back,
and in any case will be sent for examination every three months until
discharged.
A considerable number of patients with various diseases have
presented themselves for examination on their own initiative; one has
considered whether it would be advisable to limit this freedom of
attendance, as is done in some Boroughs, but inasmuch as a few of
these cases have proved to be tubercular it would seem better not to do
so. The term Dispensary is perhaps misleading to the poorer classes,
who associate it with pre.existing Dispensaries for treatment of disease
generally. Possibly the appellation Tuberculosis Clinic or Tuberculosis
Consultative Centre would point the specific nature of our work more
adequately.
Patients marked for Sanatorium and Hospital treatment under the
London Insurance and London County Council schemes have been
satisfactorily dealt with without undue waiting. We have kept in
close touch with Dr. Mary Kidd, the Medical Officer in charge of the
Borough Council's Pre-Maternity Clinies, both in the case of tubercular
patients who have become pregnant, and in the case of patients
attending her clinic in whom she has been suspicious of tuberculosis.
During the past year we have made considerable use of our
agreement with the Hampstead General Hospital; 38 cases have been
referred to the Out-Patient Department for treatment by the
physicians or surgeons. The physicians to in.patients have also
kindly taken in cases for observation and diagnosis, and I am grateful
for their help.
Some 40 cases have been referred for radiographic observation, and
the excellent radiogram supplied by the Radiologist have been of the
greatest service. I am very glad that it is proposed to continue the
use of this department.