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71
Report of the County Medical Officer General.
residential accommodation for uninsured persons, it has been taken that for adults 160 hospital beds and
240 sanatorium beds may be regarded as sufficient initial provision, excluding advanced cases. It has
been recognised throughout that these cases present a separate and distinct problem.
In dealing with the question of the sanatorium accommodation required for children it has to be
borne in mind that the problem of the treatment of tuberculous children presents special features some
of which are referred to in the section of this annual report dealing with the work of the school medical
officer. The important factors in dealing with children are (1) the question of education; (2) the
position of the day school for physically defective children established under the Elementary
Education (Defective and Epileptic Children) Act, 1899, more particularly for surgical cases; (3)
the question of the open air day school attached to the local dispensary for children in attendance
there for treatment, the majority of whom would be pulmonary cases. As to education the Council
has decided that children capable of receiving education during their stay in residential institutions
shall be sent only to institutions recognised by the Board of Education under the Elementary Education
(Defective and Epileptic Children) Act, 1899. Day schools for physically defective children under the
Education Act of 1899 have already been extensively established in London, and experience has shown
the type of case most suitable for these institutions. The matter is consequently largely one of the
selection of suitable cases. The development of the open air day school for medical cases requires
special consideration and an attempt is being made to deal with the matter on experimental lines with
a view to determining the type of tuberculous child most suitable for treatment at such an institution.
Having regard to these considerations it has been suggested that, as an initial provision, 350 beds for
surgical cases and 150 beds for pulmonary and gland cases would be sufficient.
On the question of the provision of the accommodation required both for adults and children the
Council was during the year in negotiation with the Metropolitan Asylums Board; reference to this
will be found in chapter xxv., page 145. The negotiations were not completed at the end of 1914, but
by the courtesy and co-operation of the London Insurance Committee it was found possible for the
Board temporarily to place at the disposal of the Council 15 sanatorium beds for women at the
Northern Hospital, Wiuchmore-hill, which had been allotted to the Insurance Committee, and these
have been used by the Council since 11th December, 1914, and the Metropolitan Asylums Board were
also able to allot to the Council 13 beds for children at Queen Mary's Hospital, Carshalton.
In addition to the negotiations with the Metropolitan Asylums Board correspondence was opened
With hospitals and sanatoria with a view to ascertaining the extent to which they would be able
to meet the additional needs. It was pointed out to them that the Council in seeking accommodation
desired to avoid the displacement of patients suffering from any disease including tuberculosis who
would otherwise be received under existing arrangements. In other words that the Council wished
to supplement existing provision by paying for beds for patients who, under existing conditions, would
be unable to secure appropriate treatment. As the result of these negotiations it was found that, under
normal conditions, the Council would have been able to obtain all the beds required at hospitals as
initial provision, at the rate of 30s. per bed per week and 20s. per bed per week for children. On the
outbreak of war, however, the hospitals found themselves unable definitely to allot beds for the sole use
of the Council. Many of them expressed themselves willing to take patients from time to time as
vacancies occurred, the beds reverting to the hospital on the discharge of the patient concerned. In
this way it was possible to arrange at hospitals for the few hospital beds required during the short
period of 1914 the Scheme was in operation. Four patients were admitted to hospitals, viz., two adults
and two children. Of these two were subsequently sent to sanatoria and two were discharged.
As to sanatoria it was found that there was insufficient suitable accommodation within a reasonable
distance of London, and it was Only possible at the end of 1914 to contract for 30 beds for adults,
viz., 20 at Maltings Farm Sanatorium, Suffolk, and 10 at Fairtight Sanatorium, Hastings, in addition
to the 15 beds for women at the Northern Hospital, Winchmore-hill, already mentioned. The number
obtained, however, proved to be sufficient for the demands made upon the Council during this period.
A considerable number of additional beds has since been obtained and at the time of writing they are
all occupied With regard to the children's beds, arrangements were completed with the undermentioned
institutions for the specified numbers of beds.—
National Children's Home, Harpenden 10 beds.
East Anglian Children's Sanatorium, Nayland 50 beds.
Alexandra Hospital for Children with Hip Disease 20 beds.
Queen Mary's Hospital, Carshalton 13 beds.
Fleet Sanatorium, Hampshire 5 beds.
Victoria Home for Invalid Children, Margate 5 beds.
At the end of 1914 it transpired that 8 men and 33 women and 87 children had been sent to
sanatoria by the Council. Of these 10 adults and 18 children had been discharged at the end of the
year, leaving (i men, 25 women and 69 children under treatment on 31st December, 1914.
Reference has already been made to the question of the provision necessary for advanced cases.
In their own interests and on grounds of public health it is desirable that these cases should be removed
from their homes, but much hardship would be caused if they were taken to large institutions at considerable
distance from their homes so that their friends would be unable to visit them. It is therefore
felt that these patients should remain as near as possible to their homes. It is thought that the
provision of medical treatment under the National Insurance Act will tend to reduce the number of
persons in infirmaries, and it has been suggested that some of the displaced accommodation in infirmaries
might be transferred from the Poor Law for this purpose,