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who undertakes to keep the patient under supervision, and arrange
for his or her re-attendance at the dispensary in due course.
This method of co-operation has only recently been started. It is
hoped that it will lead to a better supervision of definite and especially
of doubtful cases, that it will relieve the congestion at the dispensary
due to unnecessary re-attendances and prevent a good deal of overlapping.
(iv.) Any special arrangements made to secure the co-operation of
medical practitioners and the working of the arrangements for periodical
reports on insured patients under domiciliary treatment.
Patients, both insured and uninsured, are constantly being sent up
to the dispensary by local practitioners, for examination.
In all cases a report is sent to the doctor, giving the result of physical,
sputum, and frequently X-ray examinations, and suggestions as to the
best method of dealing with tho case.
The resources of the dispensary are at all times at the service of the
private practitioner.
The arrangements for the collection of periodical reports on domiciliary
cases have worked fairly well. In the majority of cases the
required report is obtained, though not always at the appointed time.
(v.) The arrangements for following up patients in cases where the
diagnosis is doubtful.
The method of dealing with doubtful eases depends to some extent
upon the class of case. If it is a legitimate dispensary case (viz., uninsured,
with no other provision for medical attention) the patient may
be kept attending the dispensary under treatment with a view to further
examination and re-examination, until a definite opinion can be formed.
In practice, however, it has been found almost impossible to find
opportunities for re-examining these cases as desired, owing to the
number of other patients who have to be seen. This quickly leads to an
accumulation of undiagnosed cases, which hampers the working of the
dispensary, so that, except in very suspicious cases, the patient is not
kept attending, but an appointment is made for re-examination after
a stated interval.
If the case has been sent up by a panel or private doctor, it is referred
back to him with a request that he will keep it under observation, and
send it up for re-examination later. Insured cases in which there is
considerable suspicion may be recommended to hospital for observation.
Suspicious cases among school children are dealt with, as already
explained, by arrangement with the School Medical Department.
(vi.) The arrangements for securing the examination and systematic
supervision of " home contacts."
Home contacts are for the most part examined at the dispensary,
it being the duty of the health visitor to arrange for their attendance at