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72
Annual Report- of the London County Council, 1914
Much attention has been given to the question of linking up the dispensaries with the various
local agencies for the relief of sufferers from tuberculosis and with the arrangements for residential
treatment. The medical officers of health of the metropolitan boroughs are required under the Tuberculosis
Regulations, 1912, to make enquiries into environmental conditions of all notified cases and they
have power to arrange for the improvement of unsuitable conditions and for the prevention of the
spread of infection. Their enquiries enable them to ascertain whether sufferers are receiving adequate
attention, and, where dispensary schemes are in operation, to secure attendance at the dispensary of
suitable cases and of contacts and suspects. It is contemplated that in course of time general practitioners
will seek the services of the dispensary medical officers for the purpose of consultation. In the
case of children the activities of the school care committees, not only lead to the acquisition of much
useful information, but afford channels for obtaining appropriate assistance auxiliary to medical
treatment. The experience of the last few months has shown the desirability of centralising these
various activities, with a view to economy of energy and to the prevention of duplication of visiting
and proposals for this purpose were under consideration at the end of the year. In the meantime
the services of the borough medical officers of health, the Invalid Children's Aid Association, and
the school care committees have been utilised in connection with the arrangements for residential
treatment.
One of the initial problems which faced the Council in undertaking the provision of residential
treatment for uninsured persons was the question of determining the type of case suitable for the various
kinds of institution treating sufferers, particularly as to the line of demarcation between "hospital"
and "sanatorium" cases, and as to what constitutes an "advanced" case. Another matter of difficulty
was the procedure to be adopted for the admission of patients to residential institutions. This was
one of the matters referred to the Advisory Board appointed under the Council's scheme; further reference
to this will be found in chapter xxv, page 144.
Pending the preparation of the standard classification of the Advisory Board and the appointment
of dispensary care committees, the following procedure has been adopted for dealing with cases requiring
residential treatment:—
1. A clinical report form (known as form A) is filled up by the physician or surgeon recommending
the case and referred by him to the medical officer of health of the borough.
2. Form A is forwarded by the borough medical officer of health to the county medical
officer of health together with a report (form B) by the borough medical officer of health
on environmental conditions.
3. These reports are examined by the county medical officer of health and if the cases
are passed for treatment a vacancy is offered to the patient, if an adult, through the borough
medical officer of health, who obtains the signed consent of the patient to treatment and "after
care." In the case of children, in addition to forms A and B, reports are obtained from the
school care committee or Invalid Children's Aid Association, who also obtain the consent of
the parents to treatment and an undertaking to submit the child to "after care " on discharge.
4. In the event of the county medical officer of health desiring a further medical opinion
before accepting a case for residential treatment arrangements are made for the patient to be
seen by a medical referee at the offices of the public health department. The judgment of
the referee is not subject to clinical review by the Council. The referee is also to be consulted
if there is difficulty in determining the relative urgency of a number of cases awaiting treatment.
In 1914 four cases were referred to referees, and two of them were sent to hospitals. The other
two were offered treatment in hospital and refused.
5. Due notice is given to the borough medical officer of health of the date of discharge of
a patient in order that suitable arrangements may be made for his "after care " and a medical
report on the patient's condition on discharge is supplied to the borough medical officer of health.
6. In the case of children notice of discharge is also supplied to the school care committee,
and if the case is recommended by the Invalid Children's Aid Association they are also informed.
Arrangements are made for the case to be kept under the special observation of the school
medical officer.
Maternity and Child Welfare.
Material aid in promoting the rearing of healthy children is afforded by schools for mothers, infant
consultations, health societies, infant welfare associations, etc. The establishment of such institutions
has long been undertaken on a voluntary basis but in July, 1914, the Local Government Board announced
that it would henceforth be possible to make a State grant in aid in furtherance of schemes of this nature,
and local authorities were asked to co-operate. The Board of Education is associated with the Local
Government Board in the assessing of the grants to be paid.
Owing to the war there had hardly been time for local authorities to make much headway towards
the establishment of complete schemes before the end of the year, though in many cases medical officers
of health had reported in detail on the circular of the Local Government Board. A considerable amount
of voluntary work in association with medical officers of health, women sanitary inspectors, and health
visitors has been done for some time, and it may be stated that as many as 45 institutions in London
had been recognised by the Board of Education for the purposes of the grant at the end of the financial
vear closing on the 31st March, 1914.
In some instances, moreover, in spite of the difficulties of the time, appreciable progress has been
made. In illustration of this a few examples may be given,