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required to found and support tuberculosis dispensaries in the poorer London Boroughs. Kensington
and Paddington have got a joint dispensary which has been working now about two years, and
recently St. Marylebone, Stepney, and Bermondsey have followed suit, while Woolwich, Battersea,
and Fulham are about to start. In Bermondsey a provisional committee of representative persons
interested in the fight against consumption was formed in the spring of the present year, and with
the help of a contribution of £350 from the Central Fund, and a further £150 from a local appeal,
suitable premises were acquired at No. 62, Riley Street and a dispensary was started on June 15th.
The following short description of the methods, &c., was circulated along with the first appeal for
funds:—
" The dispensary will be maintained by voluntary support, will be absolutely non-sectarian
and free from all bias. It will co-operate with the Sanitary Authority, philanthropic agencies,
and Guy's Hospital, who would welcome its establishment, as they are only able to afford
temporary relief to the chronic cases who come to their out-patients' department.
It will co-operate with all local medical practitioners, and will refuse to attend any case
already in the care of a doctor. At present the majority of cases of consumption have not
consulted a doctor, and therefore have not been discovered in time for treatment.
The following is the programme of such a dispensary : —
(1) The reception and examination of patients at the dispensary, the keeping a
record of every case, with an account of the patient's illness, history, surroundings, and
present condition, the record being added to on each subsequent visit.
(2) The bacteriological examination of expectoration and other discharges.
(3) The instruction of patients how to treat themselves and how to prevent or
minimise the risk of infection to others.
(4) The dispensing of necessary medicines. (Combined with specific treatment in
suitable cases.)
(5) The visitation of patients at their own homes by (1) a qualified medical man,
and (2) a specially trained nurse, for the double purpose of treatment and of investigation
into the state of the dwelling, and the general conditions of life and risk of infection
to others and examination of other members of the family.
In addition to the provision of treatment and instruction, the dispensary acts as a centre
round which the whole voluntary organisation for the prevention and cure of consumption is
grouped. Owing to their intimate knowledge of the patient's home conditions, family history and
powers of resistance, added to the clinical knowledge obtained at the dispensary, the physicians are
able to select the most suitable cases for treatment in institutions—the early cases for sanatoria and
the late cases for homes for incurables. They can also watch carefully over patients after their
discharge. By the dispensary system it is also possible, in many cases, to provide adequate home
treatment for patients who would otherwise have to be sent away if they are to be treated at all."
The premises at present are on a modest scale, and consist of a waiting room, dressing room,
a dispensing room, and a room for the examination of patients. The staff consists of a medical
officer, a nurse and porter. The patients attend at the dispensary on certain days, those for women
and children being different from the men's. Patients' homes are visited by the doctor and nurse,
who endeavour to persuade the other members of the infected family to allow themselves to be
medically examined.
The report submitted to the executive committee at their last meeting by the medical officer
shows that between June 15th and September 30th there were 226 new patients, 413 re-visits of
patients to the dispensary, and 8 cases confined to bed and visited regularly. The nurse paid 592
visits to homes and the doctor 308. Of the 226 new patients 91 had consumption, 52 were
doubtful, and 83 other diseases. There were 106 contacts examined, and of these 10 (which were
mostly children) showed definite signs of phthisis, 23 were doubtful, and 73 seemed in good health.
I consider this a very good record of work done for a beginning, and the last item specially
shows the importance of the examination of contacts, for here are 10 cases discovered early which
would otherwise have entirely escaped till the disease had progressed.
A notable feature among the patients is the number of advanced cases with cavities in the
lungs. This is also Paddington's experience, but as with them it is expected as the work progresses
these will be replaced entirely by early cases.
I trust that some more public-spirited, men with means, when they know of the good work
being done by the dispensary will come forward with substantial help, for it cannot be carried on
without money. About £560 has already been subscribed, including the £350 from the Central
Fund, but we must get at least another £140 before the end of the year.
Portable Shelters.
During the year the Council provided three portable shelters to enable patients to carry out
the open-air treatment in their back yards. They are constructed of light wood, varnished, and
consist of a bottom, roof, two ends, and a back. The front is completely open. They are 8 feet
long, 4 feet wide, and the height varies from 9 feet in front to 6 feet at the back, the roof sloping
towards the latter.
They have been used by patients who have returned from the sanatorium, for it is only these
who have the courage and knowledge to undertake the task of sleeping in the open-air in all
weathers. As these are much appreciated the Council have decided to have three more made.
Cerebro-spinal Meningitis.
Two cases of the above disease were notified. They were sporadic in nature, and I have very
great doubts as to whether they are the same disease which was so prevalent in Belfast a year or
two back, and has occurred in frequent epidemics in America. The organism found is certainly
similar, but I have got some evidence that it is not identical, and that the disease here notified
comes under what was formerly diagnosed as post-basic meningitis.