View report page

36
Taking first the dispensary service, the Council on 13th July, 1920, and 9th November, 1920,
passed a series of resolutions modifying the Tuberculosis Scheme approved in May, 1914, with a view to
improvement in the dispensary service in the following directions:—
(1) Provision for the appointment of tuberculosis officers as assistants to the borough medical
officers of health in order to secure a fuller measure of co-operation between the tuberculosis officer and
the officers of the borough public health department for the following purposes:—
(i.) To enable the tuberculosis officer to become aware of all cases "notified" under the
Tuberculosis Regulations, 1912, and to arrange for the examination of contacts so as to secure
that "notification" of definite cases is made at an earlier stage of the development of the disease
than the results of the investigation indicated had been the practice.
(ii.) In order that there may be an exchange of information between the dispensary staff
and the staff of the public health department as to environmental and sanitary conditions of the
homes of dispensary patients. In this connection it is laid down that the tuberculosis officer
shall visit, at least once, the home of all dispensary patients both for the purpose of acquiring
first hand information as to environmental conditions and for supervising adequately the work
of the dispensary nurse, unless he considers that, in the interests of the patient, such a visit is
undesirable.
(2) Prevention of congestion at the dispensaries by the retention of doubtful cases under observation
for long periods and prolonged treatment of patients by means of drugs. With these objects (a)
the existing arrangements, under which each dispensary is linked with a hospital to which are referred
difficult cases needing the services of physicians of special experience, or the use of expensive medical
appliances to aid diagnosis, are to be supplemented by the establishment of "consulting centres" which
in addition to these facilities, will be equipped with "observation" beds; (b) the dispensaries are to be
used as centres for diagnosis and consultation rather than as treatment centres, treatment being limited
as a rule to cases requiring special knowledge, or technical skill, and to those unable to obtain other adequate
medical treatment; and (c) the fullest possible co-operation is to be developed between the dispensary,
and the school medical service so that all doubtful cases are kept under observation at school
instead of at the dispensary, the school medical staff, on the other hand, referring cases to the dispensary
whenever necessary.
(3) Staffing of Dispensaries. In order to secure adequate time for the efficient discharge of
the duties of the dispensary staff it is now laid down that the working week shall be thirty-six hours,
and that medical staff shall be allowed on the basis of one doctor for every 160 deaths from tuberculosis
in the area served by the dispensary, part time officers being employed proportionately for lower number
of deaths. Nurses are to be correspondingly employed and each dispensary is to have clerical assistance.
(4) " Following up." Experience has indicated the need for more adequate arrangements for
following up patients for whose failure to continue in attendance at the dispensary no satisfactory reason
has been ascertained, and, during the ensuing year attention will be given to the improvement of this
feature of the dispensary service.
(5) Regulations of numbers in attendance. It has also been shown that congestion at the dispensaries
and long periods of waiting on the part of the patients can be avoided by a system regulating the
attendance by means of definite appointments made with regard to the convenience of the patients in
relation to working hours and that provision for evening sessions is likely to reduce the number of lapses
from medical supervision. These matters also will come under special observation during 1921.
At the end of the year (December, 1920), the Ministry of Health issued a Circular (No. 149) to
borough councils directing the attention of the borough councils to these matters, and to the need for
other modifications in the dispensary service when "sanatorium benefit" is withdrawn under the National
Insurance Act, 1920, from the benefits provided under the National Insurance Acts. This Act is expected
to come into operation in May, 1921.
The number of dispensaries at the end of 1919 was 33, of which 9 were municipal dispensaries,
13 voluntary dispensaries and 11 dispensaries at hospitals. During the year the Wandsworth Borough
provided a new branch municipal dispensary which is of considerable convenience on account of the size
of the borough. Proposals were under consideration at the end of the year for the provision of a branch
dispensary for part of the Borough of Poplar, and it seems to be desirable that a branch dispensary should
be provided for the Rotherhithe district of Bermondsey. On the basis of staffing of dispensaries in proportion
to the number of deaths from tuberculosis in the borough dealt with above, it v. ill be necessary
to increase the total number of tuberculosis officers from 32 whole time officers, and 9 part time officers
in 1919 to the equivalent of 50 full time officers. In one or two instances assistant tuberculosis
officers have already been appointed, and it is expected that during the year 1921 the revised
standard will be in operation throughout London.
The work of the dispensaries has brought into prominence the lack of facilities for dental treatment.
The dental defects of many of the dispensary patients have been so bad as seriously to retard their prospects
of benefit from the treatment provided at the dispensaries, and, in sanatoria ; but the patients,
when willing to undergo dental treatment, have frequently experienced difficulty in obtaining it.
The Council in June, 1919, in view of the importance of this matter decided to regard the provision
of facilities for dental treatment as an essential part of the tuberculosis dispensary service, and, further,
that the grant payable by the Council in respect of approved dispensary schemes shall include expenditure
on the dental treatment of patients.
Including the City of London, eight boroughs have made provision for this treatment, and schemes
of four other boroughs were under consideration at the end of the year. Various methods have been
adopted. In some cases the dispensaries have been specially equipped for dental service and contracts
have been made with the British Dentists' Hospital to provide the dentist and necessary material; in