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The number of cases of pulmonary tuberculosis among insured persons showed during 1918 an
increase of 18 per cent, over the previous year, but among the uninsured an increase of only 10 per cent.
It appears to be fairly certain that a further disproportionate increase in the number of cases
of pulmonary tuberculosis among insured persons as compared with uninsured persons will be shown
during the year 1919.
In connection with the detailed work of the dispensaries the first point which calls for comment
is the amount of time actually worked by the tuberculosis officers. This varies widely for whole.time
officers. The time actually spent at work was calculated from information given by tuberculosis officers
in a large number of dispensaries. As examples the following may be given—viz., 37, 42, 37, 37, 36,
35, 30, 46, 23½, 32, 39, 37£, 34, 33, 41£ hours. It was somewhat striking to find that short hours were
frequently worked in dispensaries where the number of attendances per annum were very high.
It appears to be desirable to define a whole.time appointment in terms of the hours worked.
It is, therefore, suggested that a whole.time officer should give not less time to the work than 36 actual
working hours in each week.
A definite standard would be of great use in determining the need for additional medical officers,
assessing the salary in the cases of part.time officers, etc. A similar rule might apply to the hours of
nurses, clerks and dispensers.
Premises.—London dwelling.houses do not lend themselves well for conversion into dispensaries
owing to the fact that they have usually too few rooms on the ground and first floors. This often results
in a shortage of dressing.room accommodation.
The dispensary at Battersea is possibly rather small for the needs of the borough, but even here
with some slight rearrangement of the use of rooms, a second consulting room could be provided. In
this case the dispensary is conveniently situated and otherwise suitable.
Duration of clinics.—The average duration of sessions appears to be between and 3 hours;
in five cases the sessions frequently exceed three hours, and in two of these average 3f and 4 hours
respectively. The number of patients dealt with per hour varies very considerably.
In dispensaries where the number of patients is so limited or the dispensary is so well staffed
that the tuberculosis officer has time to deal thoroughly with every case, the number of patients who
are dealt with by each tuberculosis officer, including new cases, re.examination cases and those for
treatment, averages about eight per hour.
Assuming as appears to be usually the case, that the majority of patients under treatment, observation
or supervision attend once in 14 days on an average, the constitution of the eight cases will be
somewhat as follows
One new case requiring 20 minutes for examination and record.
Two re.examination cases requiring 10 minutes for examination and record.
Five treatment cases requiring four minutes each.
On an average re.examinations are made once in six weeks in dispensaries, where about eight
patients per hour are seen. These figures are necessarily approximate, but they appear to form a rough
guide to the number of patients who can be dealt with effectively per hour.
It is somewhat striking that nine out of ten hospital dispensaries (St. Bartholomew's not reported
upon) are included under this group, together with one municipal dispensary.
Re.examination of patients under treatment, observation or supervision once in eight or nine
weeks on the average appears to be associated with an attendance of about 12 patients per hour.
The number of patients dealt with per hour at certain of the dispensaries is very high, and is
associated with infrequent re.examinations. The average period between examinations in the case
of these dispensaries is probably four or five months, and it was admitted in one dispensary that the
peri< d might even be six, nine, or 12 months. The medical officers of these dispensaries agree that
work carried out on these lines is inefficient, and they attribute it to the congestion of the dispensaries.
The reasons for this congestion will be discussed later under the sections dealing with " Observation "
and " Treatment."
The same remarks apply in a lesser degree to one or two other dispensaries which have had only
part time tuberculosis officers during the war, but here these conditions appear to be only temporary.
Arrangements for the attendance of patients at dispensaries, etc.—In the case of a disease like tuberculosis,
where so much depends upon the earnings of the patient and the need for keeping every patient
under observation for long periods even where there is no evidence of active disease, it is important that