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which the date of the next visit is recorded. If the patient fails
to attend, his absence can be noted and the matter passed on to the
clerical or visiting staff, who deal with it and report back to the
medical officers.
The Dispensary as a Centre of Treatment.
The primary object is that no single case of tuberculosis in
the community should remain uncared for. It is intended that
the Dispensary should be a centre for the organisation of treatment
within its appropriate area. This function should be carefully
interpreted. In the past, in some places, Dispensaries have not
functionated to the best advantage, because, with a limited staff,
they have over-reached in certain directions and have thus put the
whole work on a lower level. Take, for example, the routine
treatment of tuberculous patients while they are living at home.
It is unwise of a Dispensary to attempt to give such treatment
except on a strictly limited scale. There seems to be no reason
why Tuberculosis Officers should attempt to treat large numbers
of patients. General practitioners are qualified by education and
experience to give, if they choose, the utmost care and skill in the
home treatment of the tuberculous. It is all a matter of the intensive
study of each case throughout the course of the disease. Suscessful
treatment demands that, and it is essential that the Dispensaries
should carry that out in their practice if they are to
organise treatment. There are about 200 medical practitioners
living in or coming into Camberwell. The distribution of the
tuberculous patients in the Borough among so large a body of men
and women allows of an intensive study of each case throughout
the whole period of treatment. The position of Tuberculosis
Officers in this part of the work should be mainly that of consultants.
In connection with the provision of domiciliary treatment of tuberculous
persons insured under the National Health Insurance Acts
Tuberculosis Officers are the official consultants. Their services,
in the same capacity, are available to the local practitioners in the
case of any un-insured person.
The patients chosen for dispensary treatment may include
some requiring ordinary treatment and some requiring special
treatment. In choosing patients for ordinary treatment the
financial stress of the patient may be taken as one criterion. No
patient should be treated at the Dispensary who is under a local
medical man or hospital unless by arrangement. Where patients
are not insured (N.H.I.) or are not able to pay for a private doctor,
the district medical officers and the general and special hospitals
are available. The special hospitals, however, should not attempt
to treat such large numbers of tuberculous patients that the inevitable
result is lack of full study of each case from want of time.
Hospitals which undertake to treat tuberculous patients in their