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out-patient departments should make themselves acquainted with
the condition of the homes of the patients. The almoners departments
in some hospitals are fully alive to the importance of this.
Arrangements should be made in the case of patients attending outpatient
departments for treatment, to allow of their being medically
visited at home at such times as they ought to be resting in bed or
in the house. It is quite a common thing for patients to rise from
the sick bed to visit the hospital on the day their attendance is due.
In carrying out its function as a centre of treatment the Dispensary
acts as a link between the local practitioner and the authorities
giving residential treatment. Nearly all applications for residential
treatment under the scheme of the London County Council are prepared
and presented to the London County Council by the Tuberculosis
Officers, who, in the large majority of cases, are consulted in the first
place as to the advisability of each application for such treatment.
Local practitioners, the Medical Superintendent of the Infirmary, and
King's College Hospital use the Dispensary in this way, and thus
contribute to the homogeneity of the whole scheme of residential
treatment in the Borough. The services of the Tuberculosis
Officers are available at any time to any practitioner who wishes to
obtain residential treatment for a patient. If in consultation
residential treatment was agreed on, it would be the duty of the
Tuberculosis Officers to push the application for treatment with the
available authorities responsible for the provision of such treatment.
If the Tuberculosis Officers did not agree that such treatment was
necessary, the views of the practitioner would still be made known
to the authority responsible for residential treatment. In many
cases the patient would be in a position to make private arrangements
for residential treatment. The same co-operative idea applies to
all measures auxiliary to treatment, e.g., if a practitioner on making
an intensive study of his patient finds that certain things are neededmaterial
things to make home treatment satisfactory—he is at
liberty if he will—to consult with the Tuberculosis Officers on the
needs of the case. It would then be the duty of the Tuberculosis
Officers—with the consent of the practitioner and his patient—
to bring the matter to the attention of the Care Committee with a
view to helpful action. It is well to remember that even negative
results have a definite value in the building up of a useful scheme
of co-operation. It is only by constant pointing out of needs by
those in charge of treatment that an effective Care work scheme
will be reached.
If the Tuberculosis Officers are to do justice to their work
as consultants, and if they are fortunate enough to gain the confidence
of their brethren, their time will be largely occupied in the work of
home treatment. If, in addition, they attempt to take entire charge
of more than a very limited number of patients, their usefulness
will soon be over-reached, and other parts of their work will also
suffer.