For the purpose of regular dispensary and inspection work, the dispensary limits itself to receiving patients from certain districts of the city, though as a state institution it is impossible for the dispensary to refuse any case, no matter where they live, if they insist upon treatment. Usually by a little persuasion, however, we can get the patients to go to the dispensary in their district, co-operating in this way with the Phipps Institute of the University of Pennsylvania, the Gray's Ferry State Dispensary, the Kensington Tuberculosis Dispensary and the Frankford State Dispensary. The section of the city from which we draw our cases is divided, for purposes of inspection and Social Service Work, into three districts with a nurse assigned to each, and this gives each of our nurses, roughly speaking, about seventy-five patients per month to take care of. These patients
must be visited regularly every two weeks, which gives the nurse at least one hundred and fifty visits a month to pay, not including the visits to new cases.
Every new case which is admitted to the dispensary must be visited within one week of the day of admission. The nurses come in from their visiting work and report daily at 12:30 o'clock, for one hour in the dispensary office, and new cases, according to the district in which they live, are assigned to the nurse having charge of that district. The advantage of having a nurse report daily to the dispensary at a time when all the doctors are there, lies in the fact that the doctor has thus the opportunity of talking over with the nurse the new cases which she is to visit and of making any suggestions which he has gleaned from the history and examination of the patient. It is thus possible for the nurses to visit the new cases in the afternoon of the same day. The advantage of this close co-operation between doctor and nurse must be at once apparent. Further, each nurse is required to report to every physician one morning a month, with the histories in hand of all the patients of that particular doctor which are on her list. This is valuable, because in no other way can the doctor get so thorough an understanding of the home conditions and social problems of a given patient as by talking the situation over directly and personally with the nurse in charge."
A similar plan is in operation at the other two State Department Clinics in Philadelphia.
The best known tuberculosis dispensary in Philadelphia, conducted by a private organization, is the dispensary connected with the Henry Phipps Institute. This dispensary during the eleven years of its existence has contributed greatly to the standardization of tuberculosis dispensary work, not only in Philadelphia, but throughout the entire country. Connected with a scientifically conducted hospital for advanced cases, with its laboratories and other improved medical facilities, the Dispensary of the Henry Phipps Institute occupies a high place among the similar institutions of this country. The nursing staff of the Henry Phipps Dispensary consists of three visiting tuberculosis nurses, aided by two additional nurses (both colored) assigned by other organizations to work on the Phipps Dispensary staff, one by the Whittier Centre, and the other by the Pennsylvania Society for the Prevention of Tuberculosis. Some of the important features of the work of this dispensary in its relation to nurses are as follows:
(1) An efficient training school for tuberculosis nurses, affording the opportunity of hospital and dispensary training.
(2) A course of lectures on tuberculosis given to the nursing profession at large.
(3) Intensive home work among tuberculous families.
Visiting tuberculosis work in Philadelphia is also done in connection with the Presbyterian Hospital Tuberculosis Clinic, St. Stevens Church Tuberculosis Clinic, and by the Visiting Nurse Society of Philadelphia.
PITTSBURGH