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patients should be seen promptly and at times convenient to them. The general arrangements throughout
London are that the dispensaries are open between certain hours and patients come at intervals throughout
these hours. In most cases the patient has to wait for some time before he is seen, but this period
we are informed does not appear to exceed an hour on the average; . in those dispensaries where the
attendance is small it is less and in others where the attendance is large it may occasionally be much
more.
In some dispensaries patients are seen at special hours for special purposes, e.g., re.examinations,
but this is done mainly for convenience of tuberculosis officers. In two or three dispensaries special
appointments are made for the attendance of patients who cannot come at the hours of the ordinary
clinics.
A system of seeing patients by individual appointment was tried and abandoned at one dispensary.
Nevertheless, the matter is of such importance that some further attempt should be made to deal with it.
Experimental work on the part of the tuberculosis officers in this direction should be encouraged.
It frequently happens that there are so many patients attending at a particular session that
re.examinations due, or overdue, are either postponed or performed under circumstances which impair
their efficiency. It is very desirable that certain sessions should be devoted entirely to examinations
and re.examinations of patients and others to such work as special forms of treatment, etc. In a number
of dispensaries a beginning has been made in this differentiation of sessions for the special purpose of
examining and reporting upon Pensions Ministry cases.
Times of sessions.—These call for little comment. An evening session for workers should, however,
be instituted at Poplar. The question of evening sessions might be considered with advantage at
Brompton, St. Thomas' and St. Mary's Hospitals.
The habits of patients appear to have altered since 1914, and I think there is evidence that in
most areas the evening session should usually commence between six and seven o'clock instead of at a
later hour.
There is a Saturday morning clinic for children at Victoria Park Hospital which is exceedingly
well attended. The question of instituting clinics on Saturday mornings for children attending school
is worthy of attention. Children lose an attendance mark and consequently the education authority
a portion of the grant if they attend at a dispensary during the school week and this militates to some
extent against the attendance of child.contacts for examination..
Need, for branch dispensaries.—There are two boroughs in which the question of a branch dispensary
needs consideration—Poplar and Bermondsey.
Poplar.—This borough is about four miles in length from north to south and about a mile in width
from east to west. The dispensary is situated about a mile from the northern limit of the borough. The
only means of transport available for the inhabitants of the southern half of the borough to the dispensary
are the railway from the docks to Bow Station and trams and motor buses along East India Dock Road
and Burdett Road, neither of which are convenient. I estimate that a journey from some parts of the
borough to the dispensary may take from f to 1 hour.
A dispensary is needed to serve this southern part of the borough. One situated near Limehouse
Town Hall or even further east would adequately serve the following wards—
Poplar West
„ East
„ N.W. Population 1911 census 56,390.
Millwall
Cubitt Town
This would leave a population of about 61,750 to be served by the present dispensary. An
allocation of the average number of deaths from tuberculosis during the years 1912.16 on a population
basis between the two areas shows that about 184 deaths occur in the proposed main dispensary area and
168 in the proposed branch area.
The voluntary Dispensary Committee have had the question of a branch dispensary under
consideration in the past but I understand they do not feel able at present to extend their responsibilities.
If the London Hospital establishes a dispensary as a part of the Borough of Stepney Scheme it
would then be desirable to move either Whitechapel or St. George's in the East Dispensary further east.
The best place to which this dispensary could be moved would probably be to the neighbourhood of Lime.
house Town Hall. The same dispensary could serve the southern part of Poplar. It is suggested, therefore,
that a rearrangement of dispensaries rather than a new branch dispensary should be considered. The
matter has not been discussed as yet with the n.edical officers of health of either of the affected
areas.
Bermondsey.—So far as could be ascertained at the dispensary the percentage of patients coming
from the Bermondsey and Rotherhithe areas during 1918, were 74 per cent, and 26 per cent, respectively,
whereas on a population basis one would expect the proportion to be as 64 per cent., is to 36 per cent.
This seems to suggest that Rotherhithe is not adequately served although possibly the rate of incidence
is less in Rotherhithe than in the rest of Bermondsey. Some regions of Rotherhithe are two miles from
the dispensary; there is a lack of adequate means of transport and the raising of the dock bridges
frequently causes considerable delay. I suggest the establishment in the first place of a visiting station
in Rotherhithe; later on, if experience shows that this meets a need a branch dispensary can then be
established.
Source of patients.—The records relating to this heading are kept in diverse ways at the various
dispensaries, and are not comparable, but they show that quite a number of organisations—official