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This will be met when sanction is given to the scheme which the City
Council has framed for a " dispensary " in conjunction with the hospitals,
and non-insured patients also will be able to avail themselves of
the advice and treatment of the staff. It is necessary, however,
that there should be an officer to link up the domiciliary and the
dispensary treatment, and in my opinion that this could best be
effected by the appointment as Tuberculosis Officer of an Assistant
Medical Officer of Health, who would be able to give medical supervision
in the homes, besides examining suspects and contacts unable to be
otherwise examined. The number of patients who do not obtain medical
treatment of some kind is comparatively few, but in the case of Poor
Law cases the parish doctor is often only called in when removal to the
infirmary is desired. A number of persons seem to look upon their
failing health as an unavoidable condition, and struggle along almost to
the last without medical attention, partly because they cannot afford the
time or the fee to consult a doctor, and in some instances because they
are afraid they will be ordered to give up work.
Extra Nourishment.—In the case of three patients only is there any
record of medical accessories in the way of food being supplied through
the Insurance Committee, and inquiry among medical men on the panel
reveals the fact that they were unaware of the fact that they could
order extra nourishment. It is to be deprecated that persons who, on
the ground of their own contributions, have a statutory right to it,
should be compelled to apply for relief to the charitable agencies or to
the Poor Law, or else go without.
Additional beds and bedding have been supplied by the Council
where separate beds were required, and air cushions have been lent in a
number of advanced cases. Additional clothing has also been provided
from various sources, especially for patients going to a sanatorium.
Another problem which is of equal importance to proper nourishment
is that of the sufficiency of house room. About 7 per cent. (52 out of
727) of adult patients were noted as living three or more persons to a
room. The first economy of the patient as his means of livelihood fail
is invariably an economy in rent. The facts, as regards children, are
even more significant—31 out of 197 children, i.e., about 16 per cent.,
were living three or more persons to a room, several members of the
same family being sometimes infected, although in only three of the
cases was the tenement legally overcrowded. Yet under conditions such
0as these it is clearly impossible either to treat the patient or to preserve
the family from infection. The simplest and least expensive method of
dealing with a patient so placed would be to supplement his rent by a
small sum each week, on condition that he moved to new and approved