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Recommendation 5.—Treatment at the Dispensary as distinct from
diagnosis, consultation and general supervision, should, as a rule, be
limited to patients whose continued treatment requires special knowledge
or technical skill, and to those who are unable to obtain other adequate
medical attendance. Patients who require treatment which can consistently
with the best interest of the patient be properly undertaken by a
general practitioner of ordinary professional competence and skill, and who
are either insured persons or can afford to pay for mcdical attendance,
should rot be encouraged to attend the Dispensary for icutine treatment.
This recommendation is being carefully observed so far as it is practicable
to do so, and the efforts already taken in this connection have been
successful in limiting treatment at the Dispensary to non-insured cases
whose circumstances prevent them from obtaining adequate treatment, and
in such other exceptional cases as the circumstances justify.
Recommendation 6.—The practice of treating patients at the Dispensaries
on a large scale and over prolonged periods with bottles of medicine,
cod liver oil, etc., and of giving medicines to insure the attendance of
patients, should be discouraged. Patients should rather be educated out
of the belief in the efficacy of drugs, and be taught the value of personal
advice and of instruction in a hygienic mode of life.
The attitude of the Tuberculosis Dispensary Committee in relation to
this recommendation will, no doubt, be entirely in agreement with the views
of the Ministry, and it is clearly recognised the r61e of the Institution is
primarily preventive and educational; and steps are being taken to see
that the suggestions of the Ministry are being carried out.
Recommendation 7.—The fullest possible measure of co-operation should
be developed between the Dispensary service and the School Medical Service,
and children attending the Dispensary who are probably not suffering from
Tuberculosis, and others suffering from ill-health not due to Tuberculosis,
should be transferred to the School Medical Department, arrangements being
made for these children to be referred back to the Dispensary for further
examination whenever necessary.
This recommendation is fully recognised and acted upon, and the procedure
adopted at the Battersea Tuberculosis Dispensary aims at securing
the freest possible intercourse between the Dispensary service and the School
Medical Department. Doubtful cases sent for examination, but in whom no
positive evidence of Tuberculosis is disclosed, if their general health is
unsatisfactory, are reported, with notes of the case, to the School Medical
Officer for further observation, and for such special care and treatment as
the School Medical Service provides. Should a child not improve, or show
unfavourable signs or symptoms, it is again sent to the Dispensary by the
School Medical Officer, with such notes of his observations as may be useful
to the Tuberculosis Officer. It is usual also for the Tuberculosis Officer to
request the School Medical Officer to send doubtful cases for examination
at intervals of three months.
Recommendation 8.—It is desirable that at least one evening session
in each week should be arranged at each Dispensary, and the question
should be considered of instituting a special session on Saturday morning,
or at some other suitable time out of school hours.
An evening session is held on Thursdays from 7 to 8.30 for the convenience
of patients whose business or occupation does not permit of their
attending the morning or afternoon session. The question of a special
morning session on Saturdays has been under consideration, but for the
present it is not feasible to carry out the suggestion. The Dispensary is,
however, open on Saturday mornings, and later it may be possible to make
arrangements to meet the suggestion of a morning session.
Recommendation 9.—Efforts should be made to introduce at the
Dispensaries a system by which patients could be seen, if practicable, by