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61
been pointed out before, most dispensary statistics
show a gradual decrease, a marked one being seen in
the death rate which has become halved during the
past 20 years. Both local and general factors are
responsible for the changes, and there is no doubt
that changes in procedure formulated by memoranda
and regulations from the central authorities have a
large influence on dispensary figures. In connection
with this it might be pointed out that no official
visits to the Fulham Hospital have been included in
this year's statistics.
Much unnecessary work is slowly but surely
eliminated, and out of it has evolved a much more
effective scheme in which the General Practitioner, the
School Medical Officer, the Tuberculosis Officer and
Staff, the Sanatorium Medical Officer, and the Administrating
Authorities all play their part in the campaign
against Tuberculosis.
Institutional Treatment.
The London County Council is the authority
responsible for sanatorium treatment recommended
through the Dispensary or from the General Hospitals.
In this connection it should be noted that according
to the instructions of the Ministry of Health, patients
living in the borough area who are admitted to public
institutions for treatment of tuberculosis under the
Tuberculosis Scheme, although they may never have
been under the Tuberculosis Officer or even been seen
by him, are placed upon the Dispensary register for
the period of such treatment.
In 1931, 230 patients were sent to residential
institutions on the recommendation of the Tuberculosis
Officer. Of this number 139 were dealt with by
the London County Council, and 47 by the Public
Assistance Committee. In many cases the Public
Assistance Committee would send further recommendations
for Sanatorium treatment to the London County
Council.
The problem of the advanced case has always been
one of great difficulty; and their effective treatment