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When urgent symptoms arise patients are at liberty to attend
during any session, but, as a routine, attendance once a month
is quite sufficient to ensure a careful watch being kept on each case.
It will be seen from the above figures that the number of attendances
and the number of examinations have both decreased, but
that the decline in the number of attendances is greater than that
in the number of examinations. One Medical Officer cannot do the
same amount of work which was formerly done by two.
An approximate standard of the work which should be done at
the Dispensary is obtained from the number of primary notifications
of Tuberculosis, which was 455 in 1921, i.e., approximately 38 a
month. Taking contacts into account there should therefore be
about 190 examinations per month. A reasonable margin above
this has been maintained. It has only been possible to maintain
this level by spacing out the attendances of chronic cases, and by
discharging cases which show no evidence of Tubercle.
Under the present system, I believe that it will be possible for one
Medical Officer to conduct the Dispensary to the satisfaction of the
Ministry of Health, London County Council and Borough Council,
and without detriment to any Tuberculous person in the Borough,
though it is necessary to point out that the work is always heavier
during the winter, and that this report is based on the experience
during the summer months of the year.
With regard to the requirement of the Ministry of Health, in their
circular of December, 1920, that the Tuberculosis Officer should
visit the home of every patient at least once, this will be somewhat
difficult to carry out. Sixty minutes is estimated as the time
necessary for each home visit by the London County Council, and
as there are about ten new cases a week, this means 10 hours out of
the Dispensary time of 36 hours per week. This requirement has
been cut down by the London County Council in their letter of July
15th, 1922, presumably with the cognizance of the Ministry of Health,
and personally I do not think it is necessary to visit every home.
The present practice is only to do this where the nurse thinks a
personal visit of the Medical Officer is advisable."