SUBDIVISION OF TUBERCULOSIS DISPENSARIES. KARL SCHAEFFLE, M. D., Medical Inspector of Dispensaries (Acting). The year 1914 was characterized by a general increase in the activity of the system of Tuberculosis Dispensaries. This was due, probably, to the business depression, for which the year was notable, resulting in the economic conditions conducive to Tuberculosis; also to greater knowledge on the part of the laity and medical profession of the facilities afforded by the State for the cure and prevention of this disease. The opening of the Hamburg Sanatorium stimulated the interest of the people of Eastern Pennsylvania and made admission to a Sanatorium possible to a greater number of Dispensary patients. On the first of January, 1914, there were 8,252 patients enrolled in the State Dispensaries, which was increased by December thirty-first, to 9,638. New Dispensaries were established at Ardmore, Montgomery County, and Hamburg, Berks County, making the total number of Dispensaries 118, physicians 194, and nurses 122. The Dispensary in Tioga County was moved from Tioga to Wellsboro. During the year there were 4,729 applications from Dispensary patients for Sanatorium treatment. These were classified at the central office according to the physical condition of the patients recorded on charts which are forwarded with the applications. This is done to determine whether admission to Camp or Infirmary is more suitable. Preliminary and final notices were sent to each of these applicants, giving date of admission and the route and train schedule necessary to reach the nearest Sanatorium. Seventy-one inspections of Dispensaries were made, with reports upon the fitness of physicians and nurses, the amount and character of their work, the local problems of the Dispensary communities and the physical condition of Dispensary rooms and property. The work of the nurses was greatly increased by the inauguration of a "followup" system for former Dispensary patients in addition to that established for patients discharged from the Sanatoria. A supplementary report on this work will follow. The Dispensary statistics, particularly those recorded on the graphic chart, show the increase in the number of nurses' visits to be co-incident with the increase of patients enrolled; also the reduction in the amount of milk served and drugs prescribed, due to the emphasis in instructions to physicians and nurses as to the necessity for careful discrimination in their use. The tables which record the amount of social work carried on among the families of Dispensary patients are much larger than ever before, indicating the growth of the material side of Dispensary social service. The Biological Products of the Tubercle Bacillus were used more generally than in former years. A special chart illustrates the pronounced success which has attended the use of this specific agent and the infrequency of ill effects, either locally or systemically in properly selected cases. During the year, twenty-nine circular letters of instruction were mailed from the office of the Division to Physicians in Charge of Dispensaries. Other letters, to the number of 14,387, were sent to employers of labor throughout the State, each letter containing detailed information as to the nature of Tuberculosis and the principles of its treatment and prevention. These were accompanied by circulars of information regarding the State's Dispensaries and Sanatoria. The Medical Inspector of Dispensaries was requested to deliver several addresses during the year. Detailed reports were rendered by Dr. Stites following inspections of the Tuberculosis League Hospital of Pittsburgh, and the Sanatoria at Grand View, Oil City; Bon Air, Bradford; and West Mountain, Scranton. A special Exhibit, which represented the work of all the Divisions of the State Department of Health, was maintained during the session of the Medical Society of Pennsylvania held at the Carnegie Institute of Pittsburgh in September. The Exhibit was in charge of the Deputy Medical Inspector of Dispensaries, who demonstrated its features to the medical profession, students, and the public. The most notable change in the personnel of the Division was the transfer of Dr. T. H. A. Stites, who for seven years had been its able Chief, to the Hamburg Sanatorium to become the Medical Director of that Institution. Other changes in the office staff and among the physicians and nurses of our Tuberculosis Dispensaries are noted above in that part of the personal report of the Commissioner which deals with the organization of the Department. The "Tuberculosis Exhibit" continues to be an important and active agency for the direct dissemination of information of a popular character about the disease which it is the special purpose of this Division of the Department to combat and control. The Exhibit now includes at least a partial presentation of the work of every Division of |