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cases coming under the following headings : — (a) patients who have received
an adequate period of treatment in a residential institution, and have been
discharged with working capacity restored; (b) patients who, for some valid
reason, have had to leave a sanatorium before completing the full course
of treatment desirable; and (c) patients awaiting admission to sanatorium
beds.
This scheme was agreed to by both boroughs, and has now been in
operation since June of 1921. The additional diet given usually takes the
form of milk and eggs, and as far as possible the class of case selected has
been limited to those included in the headings suggested by the Ministry of
Health, although it is very hard to have to refuse the advanced case, who may
be in very straitened circumstances. It is difficult to estimate the success of
this scheme, but there is no doubt that the extra diet has been of great value
in certain cases.
The statistical tables shown below give particulars of the work of the
department for the year. There has been a decided fall in the number of
new cases for both boroughs, more marked in Hackney than in Bethnal
Green. The fall in Hackney is largely due'to the decrease in the number of
contacts, but other contributory causes for both boroughs are the smaller
number of new pension cases, the mildness of the present winter, and the
somewhat improved economic conditions. It should also be remembered that
the longer the dispensary system has been established in a borough, the
greater is the tendency to a falling off in the numbers of new cases, as once
a patient has been registered, he would, on any further attendance, be regarded
as an old case. For instance, if a patient attended the department as
a contact in 1915, when the dispensary was first opened, and was then discharged
as having no signs of tuberculosis, and did not attend again till 1922,
the patient would not be registered as a new case, but as an attendance of an
old case.
The total number of attendance during the year was 10,127,* showing a
decrease of 110 as compared with the preceding year. The number of
attendances of uninsured cases has increased by 111, so that the drop in the
total number is accounted for by the decrease in the attendances of insured
cases. Normally the number of attendances would have increased but for a
request by the Ministry of Health that the cases treated at the Dispensary
should be limited. It was pointed out by the Ministry that "the provision of
routine treatment as distinct from consultative work has at some dispensaries
been developed to an undesirable extent," and that "treatment at dispensaries
should as a rule be limited to patients whose continued treatment
requires special knowledge or technical skill, or to those who are unable to
obtain other adequate medical attention. Patients who require treatment
which can, consistently with the best interests of the patient, be properly
*Including Bethnal Green and Hackney cases.