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observation, a further report is necessary when a definite opinion is
arrived at. If a diagnosis of active tuberculosis requiring say, Sanatorium
treatment is arrived at, a detailed report with recommendation is sent
to the London County Council. The patient is referred to the
Secretary of the Care Committee who may have to refer him to the
Red Cross Society, the Guardians, the Charity Organisation Society
or other body for assistance for himself or family during his period
of incapacity for work, or the L.C.C. may have to be approached on
the question of boarding out of children, etc. Details of the case have
to be entered in the Dispensary register, giving diagnosis and classification
and an entry made in a diary as to date when next attendance is due.
A separate card index for classifaction is now kept, and cases are to be
reclassified at the end of each year. If the patient is insured, entry is
made on a further card index register for patients put on Domicilary
Treatment, and this has to be kept up-to-date re reports received or.
required from the local doctor. If reports are not received, a form
with patient's name, etc., has to be sent to the doctor when due. The
Ministry of Pensions may require a detailed report on the condition of
the patient, and later on if he is granted a pension and is on treatment,
quarterly reports are required as long as he is as a matter of treatment
considered unfit for work.
If the patient is sent to a Sanatorium a full report is sent to his
doctor on discharge when he goes on Domiciliary Treatment. Subsequently
short reports are required yearly by the L.C.C. on the
patient's condition. In addition to the above the case has to be notified
to the Medical Officer of Health, and a register of Notified Cases kept
and classified according to whether the disease is Pulmonary or
Non-Pulmonary, and the age and sex of the patients. In this register
are entered all particulars about the patient and his home conditions
with notes re admission and discharges from Institutions, subsequent
home visits, etc. It must be kept up to date and a quarterly return
made of new additions and removals. If the case is notified by a
Practitioner, he is sent a communication re examination of contacts,
and, where necessary, another as to whether or not he desires the
case to be seen by the Tuberculosis Officer. All this requires much
copying, filing, noting and letter writing. At present several people
must use the filing arrangements; one person should be responsible
for a file. The present system allows of the shifting of responsibility
for errors or papers missing.