Systems of Care and Control.

Otago Witness, Issue 3061, 13 November 1912, Page 4

Systems of Care and Control.

(A) THE EDINBURGH ANTI-TUBER-CULOSIS SCHEME. The Edinburgh scheme was begun in 1887 with the foundation of the Victoria Dispensary for Consumption. The scheme rests on the principle that, for the eradication of tuberculosis, we must not be content with treating the consumptive poor who present themselves—with more or less advanced disease—at the outpatient departments of the various hospitals. We must search for the cases at home. We must follow the consumptive patient to his dwelling and inspect it, and, as much as possible*, inspect the members of the household, so as to detect cases at the earliest stages. This is a very important aspect of prevention, and forms especially the function of the Consumptive Dispensary. The results of the Consumptive Dispensary’s activities have been most striking. Following the institution of the Victoria Dispensary for Consumption, there has gradually developed the complete system which includes a sanatorium for early cases (Royal Victoria Hospital for Consumption), with approximately 100 beds, maintained by charitable contribut'ons, and a hospital for advanced cases, with 50 beds, maintained by the municipality.

The relation between the Consumptive Dispensary and the Public Health Department of Edinburgh is intimate. The final step to the comnletion of the scheme has been taken in the foundation of a. Working colony” for selected patients, who require longer guidance than the ordinary work scheme of the sanatorium allows.

The Consumption Dispensary is in close touch with _ the Charity Organisation Society and similar agencies. The essential principle of the scheme as a whole is harmonious organisation of the several elements, the Victoria Dispensary for Consumption constituting the centre of operations, and the nodus or link of the various activities. fn) THE NEW ZEALAND SYSTEM.

Tlie New Zealand system is founded on the Edinburgh anti-tuberculosis scheme, as modified in the United States. . It differs, however, from it in the fact that the machinery provided by the New Zealand Hospital Act is much better fitted on the whole to effect an organised co-related scheme. This is due “to the fact that the Health and Hospital and Charitable Aid authorities are combined in the one central authority, the Hospital Board, a svstem based on the recommendations of the recent Poor Law Commission in Britain, and carried out in New Zealand for the first time in any country. The Edinburgh Consumption Dispensary becomes in Ota.co the Department for the Prevention n f "Tuberculosis attached to the outpatient department of the Dunedin Hospital. As vet no complete “working colony” has been established in New Zealand. When it does come, there is no reason whatever why it should not he an immediate extension of the sanatorium.

In fact, this would be preferable. Let us state in detail how the New Zealand system is working at present in Otago. When a doctor in Otago diagnoses a case of consumption he notifies the Hospital and Public Health authorities, who pass the information on to the Department for the Prevention of Tuberculosis attached to the out-patient department of the Dunedin Hospital, of which it is a branch. This department (sometimes called an Anti-Tuberculosis Dispensary) began operations in November, 1911, having the distinction of being the first to be instituted in ew Zealand. It is now under the charge of the medical director of the sanatorium, and is closely affiliated with the out-patient department for diseases of the chest under an honorary assistant physician to the Hospital. One of the nurses of the out-patient department is attached for duty as a district nurse. .On special days patients attend for medical, including bacteriological and X-ray, examinations, which latter are carried out by the honorary staff of the Dunedin Hospital. In touch with this department are the medical staff of the hospital, the district health inspectors, and the medical practitioners in the district, who pass on such information for the benefit of the patients as lies in their power. The agent of the Patients and Prisoners’ Aid Society, who happens also to be the chaplain of the hospital, is also in touch with this department. The patients are here classed according as they require treatment in (a) Sanatorium, (b) Hospital, (c) Home or Dispensary. It is the duty of the district nurse to visit the home of all patients notified, and advise as regards the nursing and the prevention of the disease, distributing suitable literature. In indigent cases she also supplies disinfectants - and sputum flasks, etc., and acts as a medium whereby the patients are brought into contact with the private and official charities. It is hoped that that part of her work which connects the dependents of indigent patients with the private philanthropic agencies will be more largely developed. Her special duty lies, however, in ascertaining the condition of health of all other people living in the house who have ran the risk of infection. She advises them to see their own doctor, with whom she communicates, and if they have none she advises them to come up for examination at the out-patient department for the prevention of tuberculosis at the Dunedin Hospital. All cases sent from the sanatorium to their homes in Dunedin are likewise after discharge under the supervision of this department, and the district nurse, who seeks to prevent relapse, and it is gratifying to note that her attendance meets with genuine appreciation from the parents and relatives of patients. The district nurse sees also the home conditions—whether they are healthy or unhealthy, and if unhealthy she corrects these where possible, and where necessary reports unhealthy houses and all cases requiring disinfection to the health inspectors.