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and in the selection of hospitals to be consulting centres there should be a variation of existing
arrangements with hospitals, each dispensary being, under the modified arrangements, linked
to a hospital which is also a recognised consulting centre.
(ii) The fullest possible measure of co-operation should be developed between the dispensary
service and the school medical service.
(iii) In each dispensary area in the County of London the normal basis of staffing should
provide for one tuberculosis officer for each 160 deaths a year in that area from tuberculosis;
part-time (preferably half-time) tuberculosis officers should assist in dispensary areas requiring
on the above-mentioned basis, the services of more than one whole-time tuberculosis officer;
and there should be one dispensary nurse (whole or part-time) for each tuberculosis officer
(whole or part-time) in each dispensary area.
(iv) The working week of each tuberculosis officer should normally be equivalent to twelve
sessions of three hours each.
(v) At each dispensary at least one evening session in each week should ordinarily be held
for the convenience of working men and women, and, where practicable, a session should be
held each week on Saturday morning, or at some other suitable time outside school hours, for
children in attendance at school.
(vi) Treatment as distinct from diagnosis and consultation at the dispensary 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.
(vii) The practice of treating patients at the dispensaries on a large scale and over prolonged
periods with bottles of medicines, etc., and of giving medicines to ensure the attendance
of patients, should be discouraged.
(viii) In order to arrive at the earliest possible date at a definite diagnosis in doubtful
cases, there should be shorter periods of observation combined with more intensive study of
each case, full use being made of the facilities and aids to diagnosis afforded by the consulting
centre.
(ix) In connection with each dispensary there should be adequate arrangements for
following up patients for whose failure to continue in attendance at the dispensary no satisfactory
reason has been ascertained.
(x) The local arrangements should be such as will enable the tuberculosis officer to visit
the homes of dispensary patients, in order to become familiar with the environmental conditions
of the patients in his district and to enable him to supervise adequately the work of the
dispensary nurses; and he should actually visit, at least once, the home of each patient unless
he considers that, in the interests of the patient, such a visit would be undesirable.
(xi) Adequate arrangements should be made for the examination by the tuberculosis
officer of the home contacts of newly notified cases.
(xii) The tuberculosis officer should become personally acquainted, as far as possible, with
all medical practitioners practising in the area served by his dispensary, in order that the fullest
degree of co-operation may be secured.
(xiii) Adequate clerical assistance should be afforded to the dispensary staff, and all
communications between the tuberculosis officer and the Council relating to the treatment or
clinical supervision of individual patients should, in future, be made direct.
(xiv) Efforts should be made to introduce at the dispensaries a system by which patients
would be seen, if practicable, by individual appointment, or other means should be adopted
to reduce to a minimum the time during which patients are kept waiting at the dispensary.
The numbers of new cases examined at the dispensaries were:—9,219 adults (insured), 5,957
adults (uninsured) and 13,182 children.
Dental
treatment.
Proposals for the provision of dental treatment in connection with dispensary treatment were
subm'tted by eleven metropolitan borough councils, the Council having in 1919, decided to regard dental
treatment as an essential part of the tuberculosis dispensary service. Seven of these proposals were
approved and the remainder were still being considered at the end of 1920.
Care
committees.
The late Local Government Board, in 1915, suggested that metropolitan borough councils should
form tuberculosis care committees in connection with local dispensaries mainly for the purpose of coordinating
the activities of public health officers, concerned with the medical side of the work, and
voluntary agencies, concerned with the social side and with the function of providing auxiliary aids to
treatment, such as additional food, change of air, clothing, better home conditions, etc. The Council
formulated a model scheme for the establishment of such committees, prescribing their constitution and
duties. In 1919, six borough councils appointed care committees (two of these borough councils
combining for this purpose to form one committee) in place of the interim committees, leaving interim
committees to be appointed by the Council in the remaining 22 boroughs. As the Ministry of Health was
considering the future constitution and functions of cafe committees, no progress was made during
1920 towards forming nermanent care committees in the 22 boroughs referred to.
Venereal
ditease.
The Council on 15th March, 1920, decided to continue the scheme, in force since 1st January,
1917, for the diagnosis and treatment of venereal diseases. Under this scheme the Council has joined
with the councils of the counties of Buckingham, Essex, Hertford, Kent, Middlesex and Surrey, and
the county boroughs of Croydon, East Ham and West Ham to utilise the facilities afforded by certain
London hospitals, for diagnosis and treatment, and (except as regards the county of Kent) to provide
laboratory facilities for aid in diagnosis and treatment. Arrangements have been made for free