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of doubtful cases that is necessary if they are to be diagnosed in a reasonable
time, and also to relieve the congested condition at many dispensaries,
it was recommended that school children in whose cases a positive diagnosis
of tuberculosis is not made at a first examination or after a brief period of
study at the dispensary, but whose general condition renders prolonged
observation desirable, should be reported with short notes to the divisional
school medical officer for this purpose, and for such special care, milk,
meals, &c., as the school organisation provides. A child whose case
took a favourable course would not return to the dispensary unless the
tuberculosis officer had expressed a desire to see it after a stated interval,
while one in whom unfavourable signs or symptoms developed would be
referred back to that officer with any notes of the condition of the child
observed by the school medical officer.
This recommendation has also been adopted and 50 children have
been transferred from the dispensary supervision to that of the school
medical officers.
(3) Cod Liver Oil and Malt, &c.—The Public Health Committee found
that the amount spent on cod liver oil and malt extract and roboleine
considerably exceeded the estimates provided. This increase was
chiefly due to the enhanced price of these articles. The Committee
considered that even at the price paid it was better to improve the health
of delicate children and adults by their administration than having later
to spend perhaps ten times as much in trying to cure the patients when
tuberculosis was definitely diagnosed. However, in view of the recommendation
of the Ministry that " the practice of treating patients on a
large scale and over prolonged periods with medicine, cod liver oil, &c.
Bhould be discouraged " the Committee decided that, in future, patients
who, in the opinion of the tuberculosis officer, are in need of cod liver
oil, &c., should be required to pay two-thirds of the cost price of the
articles, except in necessitous cases when they should be supplied with the
oil, &c., pending consideration and fixing by the Committee of the
amount each necessitous patient should be assessed to pay for such
articles.
The ideal which the Ministry consider should be aimed at is to keep
the patients in attendance at the dispensary by providing an efficient
means of " following up " and not by means of medicines. They think
that the majority of cases might, without disadvantage, be seen at longer
intervals, when it would be possible on account of the smaller numbers
attending, to make the necessary enquiries, examinations, &c., and to
impress essential advice as to personal and home hygiene, diet, &c., and
to leave symptomatic treatment as far as possible to practitioners.