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144 Annual Report of the London County Council, 1914.
as they affect the health of tcachers and children, and the physiological development of the latter. A
concise report complete in every detail is forwarded to the School Medical Officer immediately after the
inspection. Any details arising in course of the inspection that cannot conveniently be condensed are
made the subject of a special report. These reports are returned from time to time for the purpose
of recording additional notes as to the action taken to remedy defects reported. In addition, the assistant
medical officers report all conditions prejudicial to the health of the children or the teachers which
come under their notice during ordinary visits to the schools.
Between January 1st and December 31st, 1914, 121 school buildings were inspected, and in 51
cases the attention of the Buildings Sub-Committee, or the Education Officer was drawn to certain
defects in regard to lighting, ventilation, heating, drinking water, offices, etc.
CHAPTER XXV.
Public Health.
Treatment
of
tuberculosis.
One of the principal matters which engaged the attention of the Council during the year in
connection with Public Health was the treatment of tuberculosis. In the last annual report of the
Council particulars were given of various decisions at which the Council had arrived on points of
principle in connection with the provision of tuberculosis treatment. These were co-ordinated in a
general scheme which was approved by the Local Government Board. In accordance with the wishes
of the Board the scheme was prepared on the basis that dispensary treatment should be provided by the
City Corporation and metropolitan borough councils and that the Council should be responsible for
residential treatment. The Council had already decided to accept financial responsibility only for the
residential treatment of persons who are not insured under the National Insurance Acts. The treatment
of insured persons was placed in the hands of the London Insurance Committee by the National
Insurance Act, 1911, and to provide greater facilities to enable that Committee to discharge its obligations
in this direction, the Council, under its powers under Section 39 of the National Insurance Act,
1913, gave its consent to direct arrangements being made by the Insurance Committee with the Metropolitan
Asylums Board for the treatment of insured persons in the Board's institutions. Until the
passing of the latter Act the Insurance Committee had been prohibited from having any direct dealings
with the Board because of the latter's position as a Poor Law Authority.
The Council, in formulating its scheme for the treatment of tuberculosis throughout the County,
was animated by the desire to make the fullest possible use of the many agencies already available
for treating the sick, and, in particular, so to frame the scheme as to ensure the co-operation of the great
London hospitals. The object of the scheme was to link up existing agencies and others still to be
created so that they would act as a complete whole, and to provide that the patient's progress
might be adequately supervised from the time he first developed tuberculosis until the treatment
applicable to his case had been completed, and even beyond this period by the provision of
after-care.
The Council desired to avoid the possibility of its funds being utilised simply to supersede those
previously contributed through the medium of charitable organisations, and to expend the funds at its
disposal, so far as possible, in encouraging the provision of fresh accommodation or in securing the keeping
open of accommodation which was otherwise in danger of being withdrawn. It decided that it
would not itself purchase, erect, or maintain institutions.
The Council's scheme prescribes the machinery by which the comprehensive treatment of tuberculosis
is to be secured. Dispensary treatment both for insured and uninsured persons will be provided
by the local sanitary authorities, and towards this expenditure the Council will contribute, so far as
uninsured persons are concerned, amounts not exceeding 50 per cent, of the cost which would otherwise
fall on the funds of the local authority, after taking into account the Government grant of 50 per cent,
of the total expenditure incurred. The conditions under which these grants will be given were set out
in the last annual report* and are embodied in the scheme. Residential treatment for uninsured adults
and for children will be provided by the Council, and for insured persons by the London Insurance
Committee.
In order to overcome the difficulty which the Council anticipated would arise from the fact that
recommendations for provision of residential treatment would be received from a large number of medical
men in various parts of the county who would quite conceivably be working to different standards,
provision was made for the appointment of an advisory board consisting of representatives of hospitals,
dispensaries and sanatoria. The principal functions of this Board arc to assist in securing some
uniformity in standard in the selection of patients for the several kinds of residential treatment and
to appoint, either from their own number or from outside, a rota of physicians to act as medical referees
and to examine all cases referred to them by the county medical officer.
The scheme provides that the cost of the appropriate treatment of insured persons shall
be borne by insurance funds and that no part of such expenditure shall be defrayed out of the
county rate. The cost of the residential treatment of uninsured persons in institutions other
* Annual Report of the London County Council, 1913, Vol. III., pp. 226-227.