View report page

112
Further regulations and circulars have been issued by the London County Council covering
all phases of tuberculosis procedure and administration including after-care; and this authority
is now responsible for a block grant towards the cost of the service in each metropolitan area.
The Tuberculosis Dispensary.
All notified cases occurring in an area are nominally under the supervision of the
Dispensary, although many cases may have been notified by a hospital physician and attend his
out-patient department, only coming to the Dispensary if specially instructed to do so.
The sources of new patients coming to the Dispensary are various, as a glance at the
heading in the summary will show, but the majority are directly referred by private doctors.
It has always been a matter of satisfaction that the local doctors have to such a large extent
availed themselves of the dispensary service—especially in view of the fact that patients could
be equally well referred to any one of the five hospitals (one of which is world famous for
consumption and other chest diseases) within easy reach of the Borough.
A spirit of most friendly co-operation has been maintained between the dispensary service
2nd the general practitioners, and I feel that this is an important factor in the fight against the
disease, from both present and future standpoints.
{
A specialist Service has without doubt its place in the state scheme, but team work is
essential if there is to be any real success: and perhaps the most important point is the
acquisition of the patient at a stage before the disease has had time to ravage beyond repair.
The private doctor is much more likely to see the patient before anyone else and can advise
further investigation (sputum tests, X-ray, etc.) if there is any suspicion: and this investigation
is willingly carried out by the Tuberculosis Officer until the diagnosis is definitely cleared up
one way or another.
It should, however, be emphasized that no compulsion can be brought to bear on any
patient to be examined, tested, X-rayed or treated: thus all attendances are entirely voluntary.
There is no provision for coercive measures in any act or regulation yet in force—with the
exception of removal to Hospital (already quoted) in the Public Health Act, 1925.
Considering that tuberculosis is a notifiable disease just as scarlet fever, diphtheria and
small-pox are (amongst many others) and that stringent powers are available for the control of
the latter, there would appear to be a case for the operation of similar powers in the case of a
disease which is so much more fatal, and whose economic and sociological effects are so much
more pronounced and permanent. Under the present system too much is left 'to voluntary
acquiescence on the part of patients and contacts; and although statistics show a marked decline
during the past sixty years, the possibility of having nearly reached a "low-water" mark in
this respect must be visualized.
Dispensary procedure.
Patients attending the Dispensary are grouped and classified according to the type and
stage of their disease, whether actively infectious or not, and if quiescence or arrest is reached.
A patient is said to be quiescent if there are no signs or symptoms of active disease, but
only those which might be shown by a healed lesion, and whose sputum, if any, is free from
tubercle bacilli,