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of the Tuberculosis Dispensary Scheme under the altered conditions; and
in this connection it must not be overlooked that the services of the
Tuberculosis Officer are to an appreciable extent utilised, by permission of
the Council, by the L.C.C., for which they contribute £50 per annum. It
will be necessary for the Council to consider seriously whether, without
detriment to the Borough Dispensary Scheme, this arrangement can be
continued. There is, however, much more urgent need for an increase;
in the Nursing Staff of the Dispensary. There has been a tendency for the
time of the Tuberculosis Nurses to be more and more encroached upon by
indoor duties, and, moreover, a considerable proportion of the time of one
of the Nurses is utilised by the L.C.C. at the Springwell House Open-air
(Tuberculosis) School. Representations have, since the opening of the
Dispensary, been made by the Borough Council to the Ministry of Health
for the appointment of two additional Tuberculosis Nurses for the
Dispensary, but the Ministry have seen their way to sanction the appointment
of one Nurse only. That this addition will be found sufficient to meet
the needs of the Dispensary Scheme is, I am strongly of opinion, improbable.
Recommendation 3.—The Ministry understand that the L.C.C. propose
to arrange for the provision of a sufficient number of Consulting Centres
tc serve the whole of the Dispensaries in London. These Consulting Centres,
equipped with observation beds, aud having physicians with special experience,
will be provided, if possible, at certain of the London hospitals.
Tuberculosis Officers will have access to the observation beds, and consultations
upon the occupants of these beds, and upon other patients brought
by Tuberculosis Officers should take place at regular intervals. When this
provision has been made, the existing arrangements of the Borough
Councils with hospitals will be unnecessary, as each Dispensary will be
linked up to one of the Consulting Centres.
This arrangement was one of the most useful and hopeful of the methods
of improving the existing dispensary system in London. It is unfortunate,
however, that up to the present it does not appear to have materialised. At
the present time, therefore, there is no definite arrangement for this provision
in Battersea. It is true the London County Council have provided
beds for Battersea cases at Brompton Hospital and Victoria Park Chest
Hospital, but these hospitals are somewhat remote and inaccessible for
patients from this Borough, and I would, therefore, suggest St. Thomas's
Hospital as being much more convenient for the provision of this service,
and that the London County Council be asked to arrange and approve
accordingly.
Recommendation 4.—In order to arrive at the earliest possible date at
a definite diagnosis in doubtful cases of Tuberculosis which present themselves
at the Dispensaries, there should be shorter periods of observation,
with more intensive study of each case, full use being made of the facilities
and aids to diagnosis provided by the Consulting Centre.
So far as Battersea Tuberculosis Dispensary is concernedj no definite
arrangements to provide these essential specialised facilities and aids to
diagnosis have yet been arranged. Up to the transfer of the Dispensary to
the Borough Council the arrangements for this purpose were carried out
with St. Thomas's Hospital, and, as a matter of fact, no interruption has
taken place in this service—the statement in the letter of the Ministry of
Health that they were informed the London County Council were arrangeing
to provide Consulting Centres for the Dispensary System in London
at certain of the large Metropolitan hospitals would, if such arrangements
were completed, have proved very useful. So far, however, there is no
information that the service contemplated has been established. It is most
important that permanent arrangements for X-ray and Skiagrams should
be completed at an early date, and with that object St. Thomas's Hospital,
which is, I understand, prepared to continue to provide these facilities,
might be asked to enter into a contract with the Council for the purpose.