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18
consideration, while three had not replied to his request for information. It is
clear, therefore, that in a very short time every borough in London will have made
arrangements for the dispensary treatment of tuberculosis. All these dispensaries
are not, however, supported in the same way, although all are more or less similar
in their mode of administration. Indeed, this is essential, because otherwise they
would not be " approved " by the Local Government Board. Some are financed
by the Central Fund Committee, who have granted money in varying amounts
for their support up to 75 per cent, of their annual upkeep, as well as of their
cost of establishment; others are supported by the Borough Councils,
subsidised by National and Insurance Funds, others are provided by the great
hospitals, with the managers of which arrangements have been made; while
another has been established by, and is under the control of, local medical
practitioners. All of them are, however, either controlled by the Borough
Councils or are in direct touch with the Public Health Departments of their
Boroughs, and have the Medical Officer of Health, and in several instances
representatives of the Borough Councils, on their Committees of Management.
All dispensaries are curative, educational, and preventive institutions. They
are based on the model of the first dispensary established in Edinburgh in
1887, by Dr. R. W. Phillip, recently knighted in recognition of his great work.
They have one or more experts in tuberculosis as their Medical Officers who
are called Tuberculosis Officers, and who examine patients at the dispensaries,
and, if necessary, visit them. These officers work hand in hand with private
practitioner^, advising and assisting them when required.
The Nurses.—There are also on the staff nurses trained in tuberculosis
work, who visit the patients at their homes to see that the directions given by
the Tuberculosis Officers or their medical attendants are carried out, and who
instruct the patients as to what they should do to prevent the spread of the
disease to others, either in their homes, their work-places, or elsewhere. A
nurse in her frequent visits becomes familiar with the family, who as they come
to trust her more and more, make her their confidant, and then if she finds
other members of the family out of sorts, or exhibiting any suspicious
symptoms, she induces them to go to the dispensary or to undergo an examination
by their private practitioner, so that the presence or absence of the
disease may be decided.
In this way thousands of unsuspected cases of tuberculosis have been
discovered.
The nurse will examine the house to see if she can detect anything which
might retard the cure of the patient, or promote the disease in others.
She advises as to the lighting and ventilation of the rooms, and notes any
insanitary conditions about which she thinks the sanitary authority might
reasonably be informed. If the patients be poor and without proper nourishment,
she reports the matter to the Tuberculosis Officer, who communicates