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may not require hospital' treatment; also patients and their families
who are in needy circumstances are brought into touch with charitable
agencies granting relief.
The Dispensary is in close connection with the Public Health
Department, the Hospital for Consumption, one or more Sanatoriums
and an Open Air Colony. One of the most important duties
of the Dispensary doctor is to visit the homes of the patients in order,
amongst other things, to ascertain whether any other members of the
family are affected with tuberculosis. If other members are found
to be so affected, measures are taken to put them under treatment for
the disease and to educate them, so that they may not be a source
infection to others.
This work in Edinburgh has led to the discovery of many other
cases of tuberculosis in the incipient stages, which, had they not been
discovered, would have been centres of infection and have led to the
further spread of the disease. In one instance the Dispensary doctor
made a domiciliary visit, and discovered nine other cases in the
family which had never been suspected. In another instance a
domiciliary visit of the doctor led to the discovery of 15 cases
occurring in the same family. Such discoveries of unsuspected
disease has led Dr. Philip to make the following remarks as to the
prevalence of this disease in Edinburgh. "Taking the city of Edinburgh
whose mortality from consumption is approximately 400 per
annum, we may assume that within the area of the city more than
8,000 are already seriously affected by the disease. This figure
applies to involvement of the lungs only."
That is to say, for every death from pulmonary consumption,
there are at least 20 persons who are suffering from the disease in a
serious form. A further result of the domiciliary visits by the doctor
is the discovery of what are called by Dr. Philip "tuberculous nests,"
that is houses, flats, or tenements, in which case after case of tuberculosis
occurs amongst different families successively occupying the
same dwelling. Dr. Philip records the following instance of a
"tuberculous nest." "In one street of 22 houses one dwelling consisting
of four flats shows a record of no fewer than 32 separate cases