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9
been prescribed. Notice of the case was sent by the lady almoner to one of her staff of voluntary
workers, and repeated visits were paid by this lady to the home. It was found to consist of one room
and to be having a prejudicial effect on the patient's health. Every effort was made to induce the
patient and immediate friends to help themselves. A letter for a suitable convalescent home was also
obtained, a charitable society was found willing to bear part of certain necessary expenses, the patient
and friends contributing the rest, and the patient spent a month or six weeks at the seaside with
marked benefit. In the meantime, the rest of the family moved from the one unsuitable room into
two which were suitable; the apparatus which had been prescribed by the physician was secured by
the combined efforts of the patient, the friends and a charitable society; and there was secured in the
home a supervised system of careful regimen, which the patient was all the more capable of carrying
out, owing to the experience gained at the convalescent home. In this manner the patient and family
were prevented from sinking into poverty, and as far as possible from spreading infection; they were
able to earn increased wages, and to live in moderately comfortable and healthy surroundings and to
support themselves. Among the principal influences by which this result was achieved were the frequently
repeated visits of a judicious friend, who, in the case under review, was supplied by the lady
almoner's department of St. Thomas's Hospital. Medical attendance at the home is not undertaken
by the hospital, and there is no medical examination of contacts.
Another organisation which undertakes similar work is the Paddington Tuberculosis Dispensary.
This will be seen to be more local and specialised than the last-mentioned. It is, in effect, a charitably
supported hospital, brought as near as possible to the home life of the patient—in this manner, that
patients receive the medical and nursing attendance of an institution, not within the wards, but in their
own homes. Based on the Edinburgh organisation, a dispensary has been started—in January, 1909—
with out-patient waiting rooms, special examination rooms and a resident medical officer. Only
tuberculous patients are dealt with, or patients suspected so to be suffering; and only those, moreover,
who are domiciled within the Borough of Paddington;* and if they have been previously under the
care of a doctor, they are required to bring a letter from him. Stated times of the day are advertised
for their examination. Certain salient facts, in addition to the medical condition, are noted about
each patient, and the next day, or as soon as may be, the specially trained nurse attached to the
dispensary visits the home, notes the circumstances, proceeds to rectify what is amiss, and makes a
report to the medical officer. In due course he also visits the home, and a system of home visiting
is undertaken and kept up under direct medical supervision. The home regimen of the patient is
carefully arranged and continuously supervised.
Furthermore, the medical officer endeavours to make a careful and detailed examination of
every member of the patient's household, having special regard to the possibility of the presence of
tuberculosis; and Dr. Williamson, the present dispensary medical officer, Stated that in this way
numerous other cases of tuberculosis are disclosed. His rough estimate, in September, 1909, was that
about 30 per cent, of the cases on the dispensary books were the result of visiting homes and of
examining contacts. This is a high figure, and would seem to indicate considerable spread of
infection; but one or two considerations require to be taken into account therewith. Some
of the cases on the books had turned out, in the event, not to be tuberculous. Another factor,
and one of much importance, is the precise standard of diagnosis which is adopted. To place a wide
interpretation on the word tuberculosis may be for the benefit of an individual patient, but may have
the effect of including cases in whom signs of active disease may not be conspicuous. It is a question of
classification Bearing these points in mind, it is a matter for consideration whether the above
figure is as strong an argument of the potency of infection, as might at first sight appear;
and whether the cases actually noted among the contacts were many more than they would have been
had a detailed examination of the same number of families of the same social class been made, not as
the result of a dispensary attendance of a tuberculous member of the family, but of some accidental
circumstance.
Other important functions are performed by the dispensary. Close relations are established with
other organisations working with similar objects. It is endeavoured to make the dispensary the local
centre of information and effort as regards tuberculosis. Notice of cases is received from St. Mary's
Hospital, for instance, from the Invalid Children's Care Association, from the district committee of the
Charity Organisation Society, from the Public Health Department of the Paddington Borough Council
from the schools and from patients themselves; and in this way it is believed that earlier notice
of patients is received than would be the case under a system of compulsory notification to the
sanitary authority. Every effort is made to find out what treatment, material or otherwise, is required
by the patient, and to put him in the way of helping himself as much as possible; and this is often
done by reference to one or other of existing charitable organisations. The medical officer of health of
the Borough, Dr. Reginald Dudfield, is chairman of the dispensary committee, which is composed of
nine persons, viz., Miss Sophia Lonsdale, two physicians of St. Mary's Hospital, one member of the
Board of Guardians, of the Borough Council, of the Charity Organisation Society, and of the
Paddington Health Society respectively, with the Vicar of Paddington. The Honorary Secretary is
Miss McGaw. On the district committee of the Charity Organisation Society the resident medical officer
of the dispensary has a seat. Financially, the dispensary is supported by charitable contributions.
Two types of anti-tuberculosis organisations have thus been mentioned, namely the ratesupported
official public health department, and the purely charitable private effort. It remains to
* Since this report was written the area served by this Dispensary has been extended so as to include a part of
Kensington.
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