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(e) Eye Cases.—These are comparatively rarely seen at the Dispensary,
but when met with they are referred to the Royal London Ophthalmic
Hospital.
(f) Surgical Cases requiring the opinion of a surgeon are referred to one
of the general hospitals, such as the London, St. Bartholomew's, and the
Metropolitan Hospital, or the Queen's Hospital for Children.
After-care in surgical cases is supervized by the surgeon originally recommending
sanatorium treatment or by one of the London County Council
after-care clinics.
(g) Convalescence for non-tuberculous but ailing children is usually
arranged through the Invalid Children's Aid Association.
(h) Nursing of bed-ridden cases is arranged through the Queen Victoria
Jubilee Institute of Nursing.
(i) General Social Care Work.—Cases of social, economic or domestic
difficulty are referred to the Tuberculosis Care Committee, whose report is
appended.
Dear Dr.—,
There are several matters connected with the organization of the new
dispensary service and certain changes of procedure which I should like to
bring to your notice.
Notification.
The consequences of notification may be serious to a patient, affecting
employment, life insurance, superannuation, emigration, etc., and it is
desirable that all possible doubt should be excluded before notification is
made.
It frequently happens that patients with suspicious signs and symptoms
are notified as cases of tuberculosis before being referred to the dispensary
for closer observation, or that such patients, being regarded by their doctors
as definite cases of tuberculosis, are sent to the dispensary with recommendations
for sanatorium treatment. There are, however, several conditions
which very closely simulate tuberculosis and which may require a period of
observation in hospital, with the very full and careful investigation which is
only possible there, before a conclusive diagnosis can be made.
If practitioners will be good enough to give a note or card of introduction
to patients referred by them for observation at the dispensary, a report of the
findings will be sent to them as soon as a definite conclusion has been reached.
I would therefore suggest that unless the evidence of tuberculosis is beyond
doubt notification should be deferred until this report has been received.
Such patients will not be notified from the dispensary until a reasonable
opportunity has been given to the patient's own medical adviser.
Treatment of Patients at the Dispensary.
The main functions of a tuberculosis dispensary are the diagnosis of
doubtful cases, the making of arrangements for institutional treatment, and