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(v) Following up Palienls in whom Diagnosis is Doubtful.—Causes of
this description are requested to attend the dispensary at frequent
intervals until the tentative diagnosis made at the first attendance is
confirmed or negatived. No " following up " of this class of patient
has been found necessary. The issue in question is of more importance
to the patient than to anyone else and our experience is that he attends
regularly and follows out other instructions in his own interest. Home
visits are paid by the health visitors, while doubtful cases are under
observation and valuable information is often obtained in this way, which
may have an important bearing on the cases in question. For instance,
the presence of an old case of " open " tuberculosis which has always
been regarded as " winter cough " at home may form an inductive link
which cannot be overlooked. Weekly records for four weeks, fortnightly
if necessary for eight weeks, with a period of twelve weeks in a very few
cases as a maximum total period of observation, usually suffice to make
a definite diagnosis. Observation can be much more accurate and results
can be obtained more quickly when patients are in bed and under skilled
supervision. This has been recognised by the London Insurance Committee,
who accept cases recommended by tuberculosis officers for
observation with a view to definite diagnosis. Beds are reserved in
the three large London chest hospitals for this purpose. The question
is of special significance in the cases of ex-soldiers applying for pensions
on the grounds of tuberculosis contracted on military service. No such
provision is made for the uninsured patients, who include children.
The provision of hospital observation beds mitigates, in a measure,
one of the grave defects in tuberculosis dispensary schemes, namely,
the want of a few beds in connection with a dispensary. If they
existed, the tuberculosis officer could observe his own cases under his
direct supervision.
In cases which come to be regarded as " arrested tubercle " or " nontuberculous,"
contact is still maintained by periodic visits to the homes
by health visitors. In many instances such patients attend the dispensary
at six-monthly intervals fixed by appointment.
(vi) Examination of Home Contacts.—The health visitors who work
under the direction of the tuberculosis officer visit all notified cases of
tuberculosis. If the patient is under treatment at a hospital dispensary,
they encourage the home contacts to go to the hospital for examination.
In a few cases the private doctor undertakes the examinations. In f
instances the school medical records are of sufficiently recent date
acceptance. In most circumstances the duty of contact examination
falls to the tuberculosis officer. This is best done at the dispensary from