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From the above sketch it is evident that the activities of the dispensary are very many, and
the experience of Paddington, which established a dispensary in January, 1909, amply proves that
there is room for an institution of this description.
During the first year of its working 857 new patients attended, paying 4,453 subsequent
visits, making a total of 5,310 attendances during the year. The work, lam informed, has increased
so much during the year 1910 that it has been found necessary to appoint a second medical officer
and increase the nursing staff.
The following are roughly particulars of the expenses which would be incurred during the
first year of a dispensary :—Medical Officer, £300 ; Nurse, £105 (including uniform) ; Clerk and
Dispenser, for records, &c., £110; rent, &c., £60; drugs, nourishment, disinfectants, £100;
cleansing and wages, £25; heating, lighting, repairs and sundries, £100; making a total of £800.
This, in my opinion, is the minimum expense which could be expected in the first year of working;
but this would doubtless be increased as the institution became better known.
As to the value of the dispensary in the war against tuberculosis there can be no two opinions;
of this I am absolutely convinced. The only question in my mind is whether it should be municipal
or voluntary.
Opinions differ very much on this point, and the matter is one which the local authority,
after full consideration of the circumstances of their district, must decide for themselves.
Tuberculosis causes tremendous ravages, and its extermination would mean an enormous
reduction in poor relief, so that any money spent in this direction is undoubtedly a first-class
investment.
If the dispensary is run by voluntary subscription it must be in close touch with the sanitary
authority if it is to be a success. This is made one of the primary conditions of a grant from the
Central Fund for providing voluntary tuberculosis dispensaries in London; for if the dispensary
and the sanitary authority do not work together it means a great deal of overlapping and waste of
energy. If the sanitary authority do not see their way to be responsible for the dispensary themselves,
a middle course would be to grant the voluntary one a subsidy, as has been recently done in
Edinburgh.
In some respects a voluntary dispensary could work more cheaply than a municipal one;
for instance, they could save the wages of a clerk or clerks by getting voluntary helpers to keep
the records and do the secretarial work. There is a lot of such work, for which I have made an
allowance of £110, but lam not quite sure this is sufficient. There is a great deal of recording to
be done, and if this is to be done properly there must be sufficient clerical staff.
The dispensary medical officer would advise disinfection and request the sanitary authority
to carry it out.
In Bermondsey, too, the sanitary authority would carry out the examination of suspected
sputum for tubercle bacilli, as they have done for many years.
Against the saving effected by voluntary workers mentioned above, it is quite possible that a
municipal authority could effect a saving of half the salaries of the medical officer and nurse by
appointing them as assisting medical officer of health and health visitor respectively.
The cost of the first fifteen months' working of the Paddington Dispensary was
£1,033 18s. 5d., but this includes an item of £228 16s. 4d. for altering and fitting up premises.
In the case of Bermondsey this would be saved, since there is an excellent dispensary ready
fitted up in 62, Riley Street, which can be had for a rent of £60 per annum, including rates and
taxes. It is part of a building belonging to the Oxford Medical Mission, and is for hire, as they are
giving up the medical branch of the work.
In June the Central Fund for the Promotion of the Formation of Tuberculosis Dispensaries
assisted in starting one in Bermondsey, on the lines laid down by Dr. R. W. Phillip in Edinburgh,
which since has done excellent work.
The full report made to the Committee on October 10th gives a very good idea of the work.
Among the many agents employed in the campaign against tuberculosis an important place
must be given to the " Tuberculosis Dispensary."
As pointed out in previous reports to the Council, some provision has been made for the
treatment of early cases in sanatoria and advanced cases in infirmaries, &c., but for the large bulk
of consumptives of the poorer classes between these extremes no provision has yet been made on a
large scale. To remedy this omission is the aim of the tuberculosis dispensary. The first dispensary
was founded in Edinburgh in 1887 by Dr. R. W. Phillip, and the system there elaborated is known
as the " Edinburgh system." It has has been very successful, for during the ten years 1897 to 1906
the death rate in that city fell from 1.9 per 1,000 to 1.1 per 1,000, a fall of "42.1 per cent., as
compared with a fall of only 17.65 per cent., or from 1.7 per 1,000 to 1.4 per 1,000 during the
same years in London. In Edinburgh the dispensary is supported by voluntary contributions, is
under voluntary management, and while at first it received no municipal support, quite recently
the Corporation decided to grant an annual contribution to it. It forms, as it were, a pivot round
which the other activities are ranged, and the whole organisation in that city therefore consists of
the following: —
1. Compulsory notification of phthisis.
2. Tuberculosis dispensary.
3. Isolation hospital for advanced cases.
4. Sanatorium for early cases with 100 free beds, supported by voluntary contributions.
5. A working farm colony for after care of sanatorium cases.
From this it will be seen that the organisation of the anti-tuberculosis campaign in
Edinburgh is very complete.
Within the last two or three years a campaign on similar lines to those which have proved
so successful in Edinburgh has been inaugurated in London. A central fund has been started,
supported by voluntary contributions, the object of which is to provide a portion of the funds