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patients are faced with social and economical problems which are formidable
obstacles to treatment, and these cannot always be referred at once to the Care
Committee for solution. In fact, most of them necessarily enter into the
consultations between medical officer and patient.
There has been a big increase in the number of new patients attending
for investigation and also an increase in the number of contacts who have
come up for examination. This is a welcome indication of the increased
availability of dispensary facilities in Shoreditch and of the value of the
general health education which has been stressed in recent years. There has
not been a corresponding increase in the number of notifications, but this no
doubt is largely due to the differences of opinion which exist even in tuberculosis
circles as to what should be regarded as definite evidence of tuberculosis
or of active disease.
Efforts have been made to develop the co-operation of the Dispensary
with the general medical practitioners in the borough. In addition to. the
larger number of new patients sent up for investigation, the increase in the
number of consultations indicates some success in this direction. Full clinical
reports are sent, usually after the second attendance of the patient, to the
doctor referring the case for observation. At the time of the opening of the
new Dispensary a circular letter was sent to the general practitioners of the
borough, a copy of which is appended.
Visits by the Tuberculosis Officer show a decline. There is little time
available for visiting, as the mornings are largely occupied with clerical and
administrative work and there are clinics every afternoon. All essential
visiting is done, but more could be done with advantage if circumstances permitted.
It may be found advisable to rearrange the Dispensary time-table so
that an afternoon can be set free for visiting only.
Sputum tests show a marked increase. It is a great advantage to have
this work done actually at the Dispensary as check tests can be carried out if
required, and the character of the sputum is sometimes of use in diagnosis
apart from the presence or absence of tubercle bacilli.
A few notes on the facilities provided by or through the Dispensary may
be of interest. Patients are sent up to the Dispensary by general practitioners
either for diagnosis (in doubtful cases) or for advice as to treatment
and arrangements to be made for admission to sanatorium. In addition, a
large number of non-insured patients come on their own initiative. If the
diagnosis is doubtful, as it frequently is in early cases or in people suffering
from bronchitis and similar conditions, they are kept under observation as
out-patients at the Dispensary, while sputum tests and, if necessary, X-ray
examinations are carried out. If there is strong suspicion but no definite
proof of the disease, arrangements are made, usually through the London
County Council, for their admission into hospital for further investigation.
If tuberculosis is found, either at first or after observation, sanatorium or
hospital treatment is almost invariably advised, both because of the more