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arranged for, either by appointing a part-time man, engaging one from a
chemist, or by appointing a whole time officer. I think, however, that at first
one who will give his services for a few hours daily will suffice.
The Building.—The Departmental Committee on Tuberculosis,
generally known as the Astor Committee (from their Chairman, Mr. Waldorf
Astor, M.P.), say "that in most instances it will probably be found that
existing buildings can readily be adapted for the purpose of a dispensary," a
view in which I concur, especially as in London this is the practice which
has generally obtained. They also add that it should be of easy access to the
working-class population, while, as to accommodation, they think that it is
generally desirable that it should consist of an office, a general waitingroom,
a committee room, consulting rooms (one or more), and dressing rooms.
There should also be facilities for laryngoscopical and bacteriological examination,
and for the provision of drugs. Such accommodation, it seems to
me, could easily be obtained in many houses in the borough.
The Capital Outlay.—The capital outlay in fitting up such a building
and making it suitable for the purposes of a dispensary should not, in the
opinion of the Astor Committee, be much more than £250. At all events,
£300 would be probably the outside amount.
The Tuberculosis Officer.—The Tuberculosis Officer will naturally be
the guiding spirit of the dispensary, who, in the words of the Astor Committee's
Report, "should be a first class clinician, with special training in Tuberculosis,"
and " should be independent of control by any other medical man so far as his
clinical duties are concerned ;" " he should decide as to the suitability of
patients for the sanatorium: the hospital for advances cases, etc.;" " he should
be in close touch with other authorities (including those responsible for Poor Law
Institutions, Charity Organization Societies, and all agencies, voluntary or
otherwise), which have an interest in tuberculous persons ; he would seem to
be the person best qualified to advise Insurance Committees in the discharge
of such duties relating to persons suffering from tuberculosis as involve
medical considerations, and that when Institutional treatment is necessary, he
would be able, to take or advise the right steps;" and " where treatment
other than in an institution is necessary, he would be able to assist in giving
it efficiently through the dispensary." It is very manifest that in order to
obtain the services of such a man, whose opinion would be respected and
accepted by the medical profession, a generous salary should be paid. The
British Medical Association have, indeed, recommended that a salary of: at
least £500 per annum should be paid, which should be the minimum salary,