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special tomographic X-rays (focusing different layers of the lung in a series of films)
have been sent to the London Chest Hospital or the Royal Chest Hospital, both of
them within easy reach for Shoreditch patients.
It is to be hoped that the proposed incorporation of the chest clinics in the
hospitals, under the National Health Service Act, will ultimately enable the whole
work of the dispensary to be carried out under a unified direction. A further advantage
of this arrangement will be the greater opportunity for consultation with other
specialist departments and perhaps also for consultation between chest physicians
now often working in relative isolation.
Nevertheless, the institution of a borough dispensary in 1931 has had its advantages.
The closer integration with the Borough Health Department and the closer
relationship with the democratic machinery of local government led to the development
of a more complete service and a fuller consideration of the social and environmental
problems which affect the welfare of the patient, particularly in such a disease
as tuberculosis. These aspects of treatment are now widely recognised in the
Tuberculosis Service and though, when the chest clinic becomes a hospital out-patient
department, there may be some danger of a return to a purely clinical approach,
the Service as a whole is probably sufficiently conscious of the importance of these
other aspects to be able not only to stand its ground but also perhaps to provoke
emulation. Moreover, the chest physician will be jointly appointed by the Local
Health Authorities and the Regional Hospital Board. Whilst this arrangement
is intended to maintain the responsibility of the local authorities for the environmental
work and to safeguard its continuation, the prospect of dual control is viewed
with some misgiving by many tuberculosis workers.
It is appropriate here to refer to the new measures of social security affecting the
tuberculous patient already introduced and in process of development. An important
step was the introduction of the scheme for special financial allowances to certain
categories of tuberculous patients under Ministry of Health Memorandum 266/T
(1943). Assistance under this scheme was restricted to patients suffering from pulmonary
disease giving up work to undergo treatment and certified as likely to regain
capacity for re-employment. Because of its limitations, the scheme was of benefit
to only a small proportion of patients. For those with no other source of income, the
scales of assistance were inadequate for the maintenance of a satisfactory standard of
living and in some cases were even less than the scales of public assistance already
available. On the other hand a few patients benefited considerably and official
recognition, even if limited, was given to a need long urged by tuberculosis workers,
namely, the need of the tuberculous patient for special financial assistance if he was to
undertake a long period of treatment before sheer incapacity forced him to give up
work. Assurances have recently been given that under the new National Assistance
Bill some of the restrictions of Memorandum 266/T will be removed ; all cases of
respiratory tuberculosis (other than married women) who have suffered a loss of
income to undergo treatment will be eligible for a higher rate of assistance. Unfortunately,
the need of the non-pulmonary cases and their families for a higher standard