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undertaken by a general practitioner of ordinary professional skill and competence,
and who are either insured persons or can afford to pay for medical
attendance, should not be encouraged to attend the Dispensary for routine
treatment."
It will be seen by the reduction in the number of attendances of insured
persons that an attempt has been made to carry out these instructions by
referring insured patients to their panel doctors for treatment. It is difficult,
however, to reduce the number of uninsured cases, as the patients are usually
unable to pay for a private doctor.
To reduce the number of children attending the dispensaries of London, the
London County Council has introduced a scheme by which children of school
age can be transferred to the School Medical Service for supervision. A
special card provided for the purpose, on which the Tuberculosis Officer gives
such particulars as name of child, date of birth, address, school attended,
together with a short history of the case and the result of his examination, is
sent to the Divisional School Medical Officer. A circular issued by the Medical
Officer of Health of the London County Council gives the following instructions
as to the class of case to be transferred :—
A. All "unsatisfactory children,"whether contacts or not, who, after a
period of observation at the Dispensary are considered to be probably
non-tuberculous, but who require supervision;
B. All contacts who on his first examination are apparently healthy:
and also as far as possible, all other contacts that he has been unable
to examine.
Each case should be classified by the Tuberculosis Officer under one of
the following headings : —
Class 1. —An "unsatisfactory child" whether contact or not;
Class 2.—An apparently healthy contact; or
Class 3.—A contact that has not been examined.
The circular further gives the following details as to the procedure to be
adopted at the school : —
Class 1 shall be—
(a) examined by the School Medical Officer quarterly, and referred back
to the Dispensary if at any time in his opinion the child should
be regarded as probably tuberculous;
(b) weighed approximately monthly, and the weight recorded on the
chart.
Class 2 shall be—
(a) examined once a year;
(b) weighed quarterly.