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Public Health. 145
than those of the Metropolitan Asylums Board will be borne by the Council, provided that in all cases
in which a patient, or the person responsible for the patient, is in receipt of an income of £160 a year
or over, and the circumstances of the case appear to justify it, a charge may be made for the treatment
received. The Metropolitan Asylums Board has agreed to receive into its institutions and to
treat at the cost of its own funds uninsured tuberculous patients sent by the Council.
The Local Government Board in approving the Council's scheme expressed its regret that the
Council had not agreed to undertake to provide the accommodation required for the needs of the whole
population of the county, insured and uninsured. The Board also raised certain minor points with regard
to the clauses relating to the payment by patients and the fees to be paid to medical referees.
The Council proceeded to secure accommodation for the provision of residential treatment and
estimated that 160 hospital beds, 240 beds in sanatoria and 150 beds for children would be required for
the current year. These beds were, as far as possible, to be taken in existing accommodation which
was not being utilised. At the same time the Metropolitan Asylums Board was asked whether it would
place 100 existing beds at the Council's disposal and provide 150 beds as an initial provision in new
sanatoria. Great difficulty was experienced in the first instance in obtaining any considerable amount
of residential accommodation, and this difficulty was greatly accentuated after the outbreak of war. The
number of applications, however, which were received for residential treatment fell below the number
which had been anticipated, and, in spite of the scarcity of accommodation, the Council was able in the
case of adults to keep pace with the demand, and in the case of children to keep the numbers on the
waiting list from becoming considerable.
The scheme did not contemplate the provision by the Council of accommodation for advanced
and chronic cases. In this connection, the Council was advised that at the time of the approval
of the scheme, there were in Poor Law Institutions in London about 2,300 tuberculous persons,
most of whom were suffering from the disease in an advanced stage, and of whom about 86 per cent.
were not insured under the National Insurance Act. It was obvious that if the Council were to make
considerable provision for cases of the type referred to, a large number of persons who could receive or
were receiving suitable treatment in infirmaries would be transferred to the new provision made by
the Council and that no advantages would accrue, which would be in any way commensurate with the
very considerable additional expenditure which would be thrown on the county rate. The Council
therefore approached the Metropolitan Asylums Board with a view to ascertaining whether the Board
were prepared to accept responsibility for such cases. The Board informed the Council that it proposed
to consider the question in conference with the Local Government Board, as it was of opinion
that some re-arrangement of accommodation should be possible which should prevent the need for
providing new institutions. At the close of the year under review no decision had been arrived at.
Several schemes for the provision of dispensary treatment were received during the year, and the
Council approved those in respect of the metropolitan boroughs of Chelsea, Deptford, Fulham, Holborn,
Kensington, Lambeth, Paddington, Poplar, St. Marylebone, Southwark and Wandsworth.
During the year, the Council, under its powers conferred by Part 4 of the London County Council
(General Powers) Act, 1907, continued to examine samples of milk forwarded to London from pieces outside
the County. The number of samples taken was 2,925. Of these, examinations of 2,839 were completed,
of which 224 were found to be tuberculous. 354 farms outside the county were visited and 10,109
cows were examined, of which 52 were found to be tuberculous. The owners of the defective animals
undertook that the use, for human consumption, of the milk from the animals should be discontinued
immediately.
Tuberculous
milk
At the beginning of the year in review the Tuberculosis Order of 1913 was in force. This
order provided for the notification to the Council, as local authority, of any cases in the County
(exclusive of the City of London) in which any cow was or appeared to be suffering from any
chronic disease of the udder or any bovine animal which was or appeared to be suffering from tuberculosis
with emaciation. Provision was made under the Order for seizure and slaughter of animals so affected
and for the payment of compensation to the owners of such animals. Under these powers, 19
animals were seized and slaughtered, and sums, amounting to £79 13s. 9d. were paid to the owners as
compensation. On 1st July, 1914, however, this Order was superseded by the Tuberculosis Order of
1914, which varied the conditions under which animals were to be valued for compensation purposes
and also varied to some extent the conditions under which an animal might be seized, but owing to the
war the operation of this Order was suspended as from 6th August, 1914. During the period in which
it was in operation four cows were seized and £28 15s. was paid as compensation to the owners.
Tuberculosis
in cows
In 1904, 1905, 1907, and 1909 to 1913, inclusive, censuses were taken by the medical officer of
homeless persons in the County of London in order to ascertain the use made of common lodging houses,
and the provisions existing for the accommodation of persons 'of the poorest class. A further census
was made on a night in February, 1914, and the medical officer submitted a report showing the number
of persons found homeless on that night in the street, on staircases or under arches, the number and
sex of persons who might reasonably be regarded as homeless on the ground of not being able to pay
for a bed, the arrangements made for the shelter of persons of this description, and other information
bearing on the question. The total number of homeless persons found was 540, as compared with 649
at the census of 1913. Following the practice adopted in previous years, the report was printed and
placed on sale.*
Census of
homeless
persons.
During the year 295 licences were granted to keep and use, as common lodging-houses, 286
premises in the County of London, and 5 licensed keepers were fined £12, with £2 10s. costs, for having
infringed the Council's by-laws.
Common
lodging
houses,
* Report by the Medical Officer, submitting the result of a census of homeless persons taken on ths night of 13th
February, 1914. (No. 1671.) Price 2d.
27715 V