DISCUSSION OX TUBERCULOSIS. 705 



hospitals for advanced and incurable cases, inasmuch as the latter 

 benefit not only the actual sufferers but also the community at 

 large by removing from among them persons who are liable to be 

 sources of infection. 



Compulsory notification must now be looked on as a weapon 

 of proved value. It is already successfully in force in South Aus- 

 tralia, New Zealand, West Australia, some Victorian towns, and in 

 the city of Sydney. It is the one and only method by which a 

 knowledge of all cases of consumption in a community can be 

 obtained. The most workable sj^stem of notification appears to 

 me to be that in which districts or groups of districts are proclaimed 

 by the central authority as areas within which notification of 

 consumption must be made. Notification becomes effective only 

 within such proclaimed areas, and it would become the duty of 

 the central authority to proclaim as notification areas only those 

 districts in which requisite machinery existed for performing to 

 the notified patients those services without which notification 

 would itself be of little use. 



The third member of the trinity of measures I have enumerated 

 is the establishment of consumptive dispensaries. It would seem 

 that here also is a fair field for the expenditure of public money 

 either in the direct foundation of these places or, preferably, in the 

 shape of special subsidies to existing hospitals to enable them to 

 maintain consumptive dispensaries. Especially in country towns, 

 where otherwise there might be an absence of machinery to deal 

 with consumptive patients, would it be useful to establish these 

 dispensaries in relation to the existing hospitals. The wonderful 

 work which has been carried out in the Victoria Dispensary, Edin- 

 burgh, established by Dr. R. W. Phillips, has amply demonstrated 

 the value of such institutions. 



The following is the programme of the Victoria Dispensary : — 



1. The reception and examination of patients and the 



keeping of a complete record of every case. 



2. The bacteriological examination of expectoration. 



3. The instruction of patients how to treat themselves and 



how to prevent the risk of infection to others. 



4. The dispensing of medicines, sputum bottles, disin- 



fectants, and even, when necessary, food. 



5. The visitation of patients at their own homes by (1) a 



qualified medical man and (2) by a nurse, for th*e double 

 purpose of treatment and of investigating the condition 

 of the dwelling and the risk of infection to others. 



6. The selection of patients for hospital or sanatorium 



treatment. 



7. The guidance generally of tuberculous patients and their 



friends and replying to enquiries on every question 

 concerning tuberculosis. 



