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dition of the patient on discharge. They express themselves as satisfied with the reports on uninsured
persons and children, but would like the reports to be sent to them direct instead of via the Medical
Officer of Health. In most areas the patient discharged to his home reports at the dispensary within
14 days ; if he does not, a reminder is sent to him or the dispensary nurse visits to secure his attendance.
In this way continuity of supervision is assured. In the case of some dispensaries, however, no steps
are taken and the patient may be lost sight of. It should be a rule that all patients discharged from
residential institutions should be seen by the tuberculosis officer within 14 days of his receipt of the
notification of discharge.
Discharge of dispensary patients.—Tuberculosis officers are generally rather nervous of discharging
patients " probably not suffering from tuberculosis." The view has already been expressed
that a reasonable period of intensive observation, not leading to a positive diagnosis, should be followed
by discharge. No doubt some of these discharged cases may ultimately break down from tuberculosis,
but this unfortunate result will be more than counterbalanced by the increased efficiency which will
result from the freeing of dispensaries from prolonged attendance of these observation cases. At present
they overcrowd some dispe saries and render the observation either of themselves or others ineffective.
No tuberculosis officer discharges patients as " cured." who have ceased to require treatment
They all advise their patients to report at intervals varying from one month to a year.
Following.up.—In view of the importance of this work it is unfortunate that so few dispensaries
have any adequate system of following.up in operation ; in some of them a system formerly in operation
has been discontinued owing to the war. No dispensary system of supervision can be regarded as efficient
which permits patients to cease attendance without the knowledge of the tuberculosis officer. If a
patient ceases to attend, steps should be taken at once to ascertain the reason. Perhaps he may have
had a relapse, in which case it is important that the tuberculosis officer should know at an early date
so that he may take such steps as are necessary in the interests of the patient. On the other hand,
the patient may not have realised the importance of continued supervision—this applies paiticularly to
arrested cases—or mere carelessness may be responsible for his failure. In such cases it is important
that explanation, advice and encouragement should be promptly given. Again, the patient may not
be willing for some reason to continue attendance; compulsion is neither possible nor even desirable,
but the dispensary should know the reason as it may disclose some defect in the working of the dispensary.
Non.pulmonary Tuberculosis.—Except for the purposes of certification for treatment in residential
institutions, tuberculosis officers see few cases of non.pulmonary tuberculosis, as these patients tend to
gravitate to hospitals. The majority of dispensaries treat cases of glandular tuberculosis, but some
object to those requiring dressings. Certain dispensaries, however, make a feature of the treatment
of non.pulmonary tuberculosis and with the co.operation, official or unofficial, of the surgical staff, carry
out excellent work. The relation of dispensaries to these cases requires consideration, but in this connection
it is difficult at present to make any definite suggestions. It would seem, however, that in so
far as the supervision of the hygiene, environment and following.up of these patients are concerned
the dispensary organisation might be utilised with advantage.
Home Visiting.—In some cases the tuberculosis officer visits the homes of the majority of his
patients to enquire into and remedy any home defects, examine contacts, etc.
Home Visitation.—In order to enable the tuberculosis officer to deal adequately with the
individual patients and also to afford him material for studying the relation of environmental conditions
of the disease in his area, home visiting in the case of tuberculosis is very important, and it should be
the recognised duty of the tuberculosis officer to visit, at least once, the home of every one of his patients.
If, in addition, the dispensary nurse regularly visits and reports periodically upon every home,
subsequent visits of the tuberculosis officer may be restricted to those homes the conditions of which
are unsatisfactory or where examination of contacts is more readily accomplished than by means of
visits of such contacts to the dispensary.
At the present time pressure of work at the dispensary, largely due to the over.treatment of
patients, has considerably reduced the amount of home visiting by the tuberculosis officer, and thus
to a large extent one of the main functions and most useful purposes of the tuberculosis dispensary
is not fulfilled. In some areas the tuberculosis officer is not expected to visit any home. This
is the case in several of the dispensaries attached to hospitals and naturally results in the tuberculosis
officer not possessing adequate information of the environmental conditions of his patients and
must impair the efficiency of his work. No tuberculosis dispensary system can be regarded as efficient
where the tuberculosis officer is not in a position to visit the homes of patients attending
the dispensary. In areas served by Central Fund dispensaries the practice of treating in their homes
patients unable to attend at the dispensaries is still maintained, but owing to the pressure of work it
has been considerably reduced. This work, which occupies an appreciable amount of time per patient,
might be abandoned with advantage.
Home Visiting by the Nurse—As a rule the dispensary nurse carries out the home visiting of
patients in attendance at the dispensary. In certain boroughs, however, other arrangements obtain.
In Hackney, Stoke Newington, and Bethnal Green, patients are visited by the health visitors of the
Public Health Department. The tuberculosis officers rarely confer with these health visitors, and the
work is carried out without adequate relation to the dispensary, and, in fact, the tuberculosis officers
deal with their patients practically without regard to their home and other circumstances. The same
applies to Margaret Street and Middlesex Hospital Dispensary areas. Here patients receive the treatment
of ordinary hospital out.patients. In the case of the Oakley Square Dispensary (St. Pancras)
and to a less extent in other areas, the dispensary nursing staff is quite inadequate to deal efficiently