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and if so, whether he comes within the regulations of the scheme provided
by the Borough for that purpose, must be investigated; (10) The question of
institutional treatment, of reference back to the Insurance Practitioner, of the
amount of supervision required, etc., must be discussed. It must be remembered
that each of these points must be kept in mind and decided by the
Tuberculosis Officer during the session itself, though the actual filling up of
the multitudinous forms and reports at present in vogue is done afterwards.
This may serve as an illustration of the complicated nature of the work of the
Tuberculosis Officers, and it will be realised how essential for efficiency
it is that the staff, both medical and clerical, should have worked together
as long as possible, and that there should be a period of unbroken continuity
of office.
Though there have been practically no variations in the work as far as
our own arrangements in the Dispensary itself are concerned, yet we are only
one unit in a scheme, and necessarily alterations in rules and regulations by
bodies responsible for co-ordinating the work of the scheme affect us. Thus
the provision of institutional treatment is in the hands of the London County
Council. In the absence of facilities for such treatment locally it is inevitable
that this matter should be dealt with by some central body, and it is equally
unavoidable that a certain amount of delay should be incurred in the admission
of patients when a large number recommended from all the Metropolitan
Boroughs have to be taken in rotation. In the spring and summer of the
year it cannot be said that these arrangements were satisfactory to us, for
not only was the waiting period sufficiently long for the whole aspect of the
case to be changed in certain instances, but a considerable proportion of our
people were unable to secure admission at all, in spite of the fact that we
endeavoured as far as possible to recommend only those who were suffering
from tuberculosis in its earlier stages, or those in whom it was probable that
a period of institutional treatment might result in at least temporary improvement.
During the latter period of the year the difficulty has not been nearly
so great, but it must be remembered that at such a season the prospect of
going away is not so alluring to the average patient.
It is always possible to secure a bed for a pensioner, and it is to be feared
that other men, many of them ex-soldiers, have suffered as a result. The
system of "preferential treatment" entails that such a pensioner, no matter
how unlikely he is to derive any permanent benefit therefrom, and no matter
how undeserving he is on grounds of war record or length of service, takes
preference over, and often excludes from institutional treatment, a man who
might be likely to do well, and who in many cases has a long and honourable
army record. Thus from the sentimental as well as from the utilitarian point of
view the system is in my opinion unsound. As I have had to state in my previous
reports, for all cases of advanced disease except pensioners there is very little