View report page

110
Tuberculosis
dispensaries
—survey of
their work.
The working of the tuberculosis dispensary service in London was the subject of a special survey
during the year.* The tuberculosis dispensary is—in the words of the Departmental Committee on
Tuberculosis—"not a building but an organism." The scheme which they recommended in 1912,
for preventing, detecting and treating the disease was based on the establishment and equipment of two
units related to the general public health and medical work carried on by medical officers of health and
working in harmony with the general practitioner. This scheme was intended to complete existing
public health administration in respect of tuberculosis. Of the two units referred to, the first consisted
of the tuberculosis dispensary or an equivalent staff, the second unit consisting of sanatoria, hospital,
etc., in which residential treatment is given. The opinion was expressed that the tuberculosis dispensary
should be the common centre for the diagnosis and for the organisation of treatment of tuberculosis in
each area, at which the various bodies and persons connected with the campaign against tuberculosis
would be brought together. The Departmental Committee expressed the view that the aim should be
that no single case of tuberculosis should remain uncared for in the community, and that whatever
services the scheme provided should be available for all cases of the disease ; that next to the tuberculosis
dispensary should stand the second unit, consisting of a system of sanatoria, hospitals, farm colonies,
open-air schools, etc., and that the tuberculosis dispensary should be linked up to these institutions, for
which it would act as a clearing house.
The Departmental Committee stated that, in a general way, the function of the tuberculosis
dispensary should be to serve as (i) receiving house and centre of diagnosis; (ii) clearing house and centre
for observation; (iii) centre for curative treatment; (iv) centre for the examination of "contacts";
(v) centre for "after-care"; (vi) information bureau and educational centre. Some of these functions
are complementary to the preventive work, under the Public Health (Tuberculosis) Regulations, 1912,
and the general powers, in relation to sanitary matters, of the municipal health departments. The
functions of dispensaries in connection with early detection of cases of tuberculosis are of great importance,
and early detection of the disease and preventive work are activities likely to yield the most fruitful
results in the general effort to reduce the prevalence of the disease. The disappointing results of treatment
of tuberculosis, as disclosed in recent statistical information to which reference has been made
earlier in this report, emphasise the importance of this side of the work.
Development
of the
dispensary
system.
The Central lund for the Promotion of the Dispensary System for the Prevention of Consumption
in London was established in 1911, and in that year eleven dispensaries under the scheme of the Central
Fund were established. In the following year two other voluntary dispensaries were established. In
the same year (1912) the Departmental Committee suggested that dispensaries should be provided by
metropolitan borough councils, which were then invited by the late Local Government Board to provide
dispensaries. In 1913, municipal dispensaries were established in 6 metropolitan boroughs. In 1914,
12 schemes of borough councils, relating to 13 separate dispensaries, were approved by the Council under
its comprehensive scheme made in that year. The number of approved dispensary schemes increased
each year until, in 1919, there were 29 approved schemes relating to 33 separate dispensaries and two
branch dispensaries. The various voluntary dispensaries were included as part of the borough dispensary
provision, and have continued on a voluntary basis subject to compliance with the requirements of
public authorities. Of the total number of dispensaries, 13 are voluntary and 9 municipal, the remainder
being established at hospitals.
During 1920, the Central Fund intimated that it was no longer able to continue its grants to the
eleven dispensaries which it had established and supported, and it accordingly became necessary for
the metropolitan borough councils in whose areas the dispensaries were situated, to consider as to the
future arrangements to be made for the maintenance of adequate dispensary service.
The medical officers of dispensaries are designated tuberculosis officers, and are selected owing
to their possessing, in addition to ordinary medical knowledge and experience, special qualifications
in respect of tuberculosis likely to command the confidence of the general practitioners in their areas.
There are in London 41 tuberculosis officers, of whom 9 have part-time appointments. In order to coordinate
the work of the public health departments and the dispensaries, borough medical officers have
been appointed "administrative tuberculosis officers," the position of the tuberculosis officer being
assimilated with some limitations to that of an assistant to the borough medical officer, except in clinical
matters, in which the tuberculosis officer is independent of control.
One-half of the cost of approved arrangements for the dispensary service for uninsured persons is
met by Exchequer grant. One-half of the balance of the cost of such arrangements, approved by the
Council in accordance with its scheme, is borne by the Council.
Views of
Council on
present
working
of
dispensaries.
In normal circumstances it would have been possible to follow closely the development of the
work of the dispensaries from July, 1914, or the later date of their establishment, as the case might have
been, but it was not possible during the period of the war to make the close investigation necessary for
the purpose of revealing the deficiencies discovered in the course of the survey undertaken during this
year. The deficiencies are largely attributable to understaffing and other conditions due to the war.
As a result of the survey, the Council, with the approval of the Ministry of Health, approved
the undermentioned proposals as part of its scheme for the treatment of tuberculosis in London, and
decided that such proposals should be severally brought into effective operation at the earliest practicable
date or dates after 31st December, 1920.
(i) Consulting centres with physicians with special experience in tuberculosis and equipped
with observation beds should be provided, if possible, at a number of London hospitals ; tuberculosis
officers should have access to these beds, and consultations upon the occupants of these
beds and other patients brought by tuberculosis officers should take place at regular intervals ;
* Tuberculosis in London. Report of the Public Health Committee. 1st July, 1920. No. 2035. Price 6d.