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70
Annual Report of the London County Council, 1914.
National Insurance Act, 1911—Treatment of Tuberculosis.
The circumstances which led to the Council making provision for the treatment of tuberculosis
in London were fully dealt with in the two preceding annual reports. Briefly stated these were that
(a) the results of the investigation of the Departmental Committee on Tuberculosis, which issued two
reports in 1912 and 1913 respectively, and (b) the requirement of compulsory notification of sufferers
under the Tuberculosis Regulations, 1912, established the necessity for public provision for dealing
with the disease. The Council first accepted a grant from the Government under Section 64 of the
National Insurance Act, 1911, which enabled it to enter into agreement with the Metropolitan Asylums
Board for the treatment of insured persons at Downs Sanatorium, Sutton, and at the Northern Hospital,
Winchmore hill. Subsequently an amending Act passed in 1913 repealed the provision in the original
Act of 1911, which prevented the London Insurance Committee from making direct arrangements with
the Metropolitan Asylums Board for the treatment of insured persons. Under the amending
Act such direct arrangements may be made subject to the concurrence of the County Council. The
Council concurred and the London Insurance Committee made their own arrangements with the Metropolitan
Asylums Board. The Council ceased to have any responsibility in respect of insured persons
on 31st March, 1914. With regard to the general community the Local Government Board invited the
Metropolitan Borough Councils to prepare schemes for the treatment of sufferers and the examination
of suspects and contacts at dispensaries, and they also invited the Council to formulate a complete scheme
for London which would embody the work to be done locally through the dispensaries and include
the County Council as the Authority for residential treatment.
First, as to dispensaries, the Council decided to make grants in aid of the expenditure of borough
councils on dispensary schemes to the extent of 25 per cent. of the cost of dealing with uninsured persons,
provided the schemes complied with certain regulations which were adopted by the Council in November,
1913. These were set out on page 226 of volume III. of the Annual Report of the Council, 1913, and
were subsequently embodied in the Council's Tuberculosis Scheme for London approved by the Council
on 26th May, 1914. Shortly stated the principal of these provide (a) that the Scheme shall include
treatment of both insured and uninsured persons (b) that the premises and tuberculosis officers shall
be approved by the Council; (c) that the dispensary shall be linked to a hospital for the purpose of
determining diagnosis in difficult cases; (d) that records, forms and statistics shall be in the form required
by the Council; (e) that the Council shall be supplied with reasonable information as to the work of
the dispensary; (f) that home visitation and examination of contacts and suspects shall be provided for;
(g) that the Scheme shall be conducted with reasonable economy and that the accounts shall distinguish
clearly between the cost of insured and uninsured persons; and (h) that the arrangements and expenditure
shall be annually submitted to the Council for its approval. At the end of 1913 qualified approval
of two dispensary schemes (Southwark and Chelsea) had been given.
By the end of the year 1914 schemes had been received from 25 Borough Councils, and 15 had
been approved. Of the 25 schemes, 7 had been in operation for varying periods prior to the adoption
of the Council's scheme and 6 others were cither fully or partially working at the end of the year.
Ten schemes were then still the subject of negotiation and four boroughs had not submitted their
proposals.
One of the principles governing the policy of the Council in respect of their approval of dispensary
schemes and of provision for residential accommodation is that wherever possible existing institutions
should be used.
In the various boroughs the following dispensary accommodation has been provided or is proposed:-
Municipal.-Deptford, Finsbury, Greenwich, Hammersmith, Hampstead, Southwark, Wandsworth.
Hospital.—City of London, Chelsea, Hackney, Holborn, Islington, Shoreditch, Stoke Newington,
Westminster.
Municipal and Hospital.—Lambeth.
Voluntary and Hospital.—St. Pancras.
Voluntary.—Poplar.
Central Fund.—Battersea, Bermondsey, Camberwell, Fulham, Stepney, Woolwich.
Central Fund and Hospital or Borough.—Kensington, Paddington, St. Marylebone.
With regard to the general scheme for London, attention was directed during 1914 to the
arrangements for residential treatment and to the linking up thereto of the local dispensaries
so as to secure the smooth transfer of suitable cases from the care of the dispensaries as in-patients
to hospitals or to sanatoria and vice versa on completion of the in-patient treatment.
On the question of the provision of beds, it will not be possible to estimate with any degree of
accuracy the number required until the dispensary schemes have had time to get fully into operation.
It might be possible to arrive at a reliable figure if the accommodation needed were dependent only
upon the notifications under the Tuberculosis Regulations, 1912, which are dealt with elsewhere in this
report, as it is probable that the number of cases notified has now reached a level which provides an
annual average of cases coming under notice as a result of medical advice being sought by persons
experiencing definite signs of illness. Dispensary schemes, however, provide for the examination of
"contacts" of notified sufferers, and it may therefore be expected that later there will be an increase
in the number of cases detected in the early stages of the disease, i.e., the type of case most suitable for
sanatorium treatment. Having regard to the fact that the Council is only concerned in providing