Waiting Room in Municipal Dispensary
The inner, or examining room, is also simple and inexpensively furnished. It is divided into several compartments by means of gas piping, each compartment being large enough to hold a revolving stool and a wicker lounge. Unbleached muslin curtains hang from these gas-pipe rods, making several little cubicles in which the patients are examined. It is thus possible for the doctor to examine a patient in one cubicle, while another patient undresses in the adjoining one—an arrangement which saves considerable time. Sheets, towels, and blankets complete the necessary furnishings, which may be cheap or costly according to the means available. The doctor’s table stands in one corner of this examining room.
This is not necessarily the last word as to what tuberculosis dispensaries should be, but we have found the ones described practical. No tuberculin tests are given here, and all sputum examinations are made at the Health Department laboratory.
Medicines. A supply of simple drugs is kept in the medicine closet. This includes a few of the standard tonics, such as iron, quinine and strychnia, nux vomica, gentian and alkali, and so forth; there are also cough syrups, and heroin, codeine, cascara, etc. The tonics are usually bought in large quantities, in gallon jugs, and in her leisure moments the nurse pours them into four- or six-ounce bottles. If these bottles are filled by the druggist, the expense is somewhat greater. This medicine is given free of charge, although now and then a patient may wish to make a small payment of ten cents or so. In themselves, these drugs cannot be said to constitute treatment, yet it has been found advisable to dispense them. Patients are so accustomed to being dosed, that they have no faith in an institution which does not prescribe for them. It is above all things necessary to make these dispensaries popular, so that patients will freely seek them, and recommend them to their friends. Only through wide publicity and extensive patronage can they become effective factors in the fight against tuberculosis.
Examining Room in Municipal Dispensary, showing the room divided into cubicles, by means of gas-piping
Hours. The hours at which a dispensary is open will depend somewhat upon its location, also upon whether or not the physician’s services are volunteered; in the latter case, it will depend upon the time he is able to give to it. If it is open in the morning, the workingman cannot attend without losing a whole day from his work, nor are these hours convenient for schoolchildren, or for the busy housewife who does most of her work before noon. If the dispensary is open in the afternoon, all three classes of patients may be accommodated; the workingman will lose half, not an entire day, while women and children can attend with no inconvenience at all. Afternoon hours, say from two till five, not only permit patients to be examined by daylight instead of artificial light, but the doctor will be further aided in his diagnosis by the presence or absence of that characteristic symptom, an afternoon temperature. Night clinics are necessary in certain localities, when they may be patronized by men and women, employed during the day, who would otherwise be unable to come to them.[[6]]
[6]. Night clinics are in existence in New York, Hartford, Boston, Chicago, and other cities, and are well attended.
Consideration for Patients. The first consideration of the dispensary should be the comfort and welfare of the patients. We have known many dispensaries where the first consideration was the experience of the students or physicians, the patient being regarded merely as good clinical material. In dispensaries connected with medical schools, which are essentially used for teaching purposes, this condition is unfortunately necessary, yet we cannot believe that it is necessary to the extent to which it is sometimes carried. We have often known of “interesting” cases being held up for hours, in order that they might be examined by certain men, or groups of students; moreover, this detention, prolonged examination, and exposure often took place when the patient was very weak, when he lost his job through the delay, or when a husband’s dinner, a nursing baby, or a houseful of children made such detention intolerable. Patients often refuse to return to a large dispensary on the ground that “they keep you all day, everyone in the place examines you, and you get so tired and sick you have to stay in bed for a week afterward.” This lack of consideration—failure to look upon the patient as a human being—is what tends to make dispensaries unpopular. We have known patients to come straight from such an experience and deliver themselves into the hands of a quack. However necessary it may be to use certain dispensaries as teaching centres, the tuberculosis campaign demands clinics of another kind. If the tuberculosis dispensary is to be a factor in the fight against this disease, it cannot afford to be a training school as well—it should be in charge of men already trained.
Function of the Dispensary. It follows, then, that the function of the municipal dispensary is of necessity different from that established for teaching purposes. The larger dispensary serves a double purpose, the little dispensary serves but one; it is an examining station for making diagnoses. Here the patient should come as informally as he would to a doctor’s office, and here he should be able to consult experienced men. We feel that the informality of these little clinics constitutes their strong point. The patients are not afraid of them, and their great advantage lies in their social rather than their scientific value. They are merely places where a communicable disease may be discovered at the earliest possible moment.