DURING the winter of 1940-41, 132 patients with pneumonia were treated in their homes by the Domiciliary Medical Service of the Boston Dispensary. This free service by the Boston Dispensary was established in 1796 for care of the indigent sick in their homes. In a discussion of this service, Wing1 states:The burden of home care of the sick who are unable to employ a physician is usually a responsibility of the local rather than of the state or federal government. It is commonly exercised as a function of the Public Welfare or Poor authorities rather than of medical institutions. . . . Boston, unlike other cities of the country, has never employed city physicians for this purpose but has accepted the services of privately supported medical charity as a substitute.The physicians on this service have two or more years of postgraduate hospital work and are appointed as fellows in medicine for one year. They spend their mornings in the Out-Patient Department, and their afternoons, in making home visits. Their work is supervised by a full-time physician who also acts in the capacity of consultant. Approximately 50,000 visits are made annually.During the winter months, many cases of pneumonia are seen, and in the past, because of inadequate home facilities for the treatment of pneumonia then available, it was necessary to hospitalize most of these patients. This, no doubt, threw ait additional burden on the already overcrowded hospitals in Boston. With the introduction of the sulfonamides, it seemed reasonable to believe that many of these patients could be successfully treated in their own homes. This led to the formation of the Pneumonia Service, consisting of four district physicians particularly interested in this work. These men were made available during and after their regular hours to study and treat patients in whom a diagnosis of pneumonia was made. Two physicians were designated to care for adults, and two for infants and children.Methods All cases of pneumonia or suspected pneumonia seen by the district physicians were referred through the district office to the physician on the Pneumonia Service, who visited the patient within a few hours. If the diagnosis of pneumonia was confirmed, the following course was instituted: the history was taken, and physical examination was made for corroboration of the diagnosis; sputum was obtained for typing, nose or throat swabs being taken in children ; leukocyte and erythrocyte counts, and hemoglobin estimations were made, and blood films for differential counts were taken; a blood culture was obtained; and a urinalysis was made.|[ Following this, the treatment was begun at once.The drug chosen was sulfathiazole, because of its effectiveness and slight degree of toxicity.2-12 It was assumed that patients were likelier to follow the treatment carefully if such distressing symptoms as nausea and vomiting were eliminated. In most cases, an amount of sulfathiazole sufficient for twenty-four hours was supplied by the physician, and the first dose was usually administered in h...
