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108
CHAPTER XXV.
PUBLIC HEALTH.
Infectious
and
epidemic
diseases.
The Council, as the central authority, maintains special arrangements for dealing with infectious
and epidemic diseases. With regard to these diseases generally, the Council provides expert assistance
in diagnosis and bacteriological examination. Returns of notifications of infectious diseases are forwarded
weekly to the Council and are examined by the county medical officer, and, when necessary,
inquiries are instituted and special reports are published by the Council. Special steps are taken with
regard to cases of infectious disease arriving in this country from abroad. The Council retains the use
of certain premises for the purpose of temporarily accommodating contacts of plague, cholera or other
epidemic disease.
Treatment
of tuberculosis.

The responsibility for the public provision of treatment for tuberculosis rests in the county of
London on the Council, which has made a comprehensive scheme under which the Council
provides or arranges for the provision of residential accommodation, and the metropolitan
borough councils provide or arrange for the provision of dispensary treatment. With regard
to residential treatment it has been the policy of the Council to take advantage of all suitable
accommodation available in hospitals and sanatoria, and to look to the Metropolitan
Asylums Board, the authority for the provision of residential treatment for infectious diseases in London,
to provide the further accommodation required. The treatment for tuberculosis of persons insured
under the National Health Insurance Acts was the responsibility of the insurance committees, and the
London Insurance Committee made their own arrangements for the residential treatment required,
and entered into agreements with the various metropolitan borough councils for the dispensary treatment
of insured persons. During 1920 the Council, after prolonged negotiations with the Insurance Committee,
concluded an agreement under which the Council became responsible to provide or
arrange for the provision of residential treatment for insured persons. Under this agreement
the Council became responsible for the cost of such treatment so far as insurance funds proved
insufficient for the purpose; any additional expense so incurred by the Council being reimbursed, as
to one-half, from Government grant. The National Health Insurance Act, 1920, provided for the discontinuance,
as from a date to be determined, of sanatorium benefit, which included the benefit of institutional
treatment for tuberculosis ; but Parliament had not determined, before the close of the year,
the arrangements to be made for the treatment of insured persons after the discontinuance of
sanatorium benefit.
During the war the London Insurance Committee undertook, at the request and at the cost of
the Ministry of Pensions, the arrangements necessary for the residential (and preferential) treatment of
discharged sailors and soldiers suffering from tuberculosis; and concurrently with the agreement referre d
to in the preceding paragraph the Council concluded an agreement with the Insurance Committee under
which the Council became responsible for the arrangements for the residential treatment of discharged
sailors and soldiers.
As a result of the transfer to the Council, under the two agreements referred to, of responsibility
as regards residential treatment of insured persons and ex-Service men, the arrangements for the provision
of all residential accommodation required through public authorities for the treatment of tuberculosis
in London were centred in the hands of the Council. The advantage of bringing into the hands of one
authoritv the arrangements for all residential treatment will be appreciated from the undermentioned
considerations. During the war, owing to pressure on hospital accommodation in connection with the
treatment of the wounded and sick from the various theatres of war, the accommodation available
for tuberculosis cases was inadequate, and as arrangements for residential treatment of London cases
were in different hands, it was not possible to secure that the best use should be made of available accommodation.
During the interval which has elapsed since the termination of the war, the available accommodation
for tuberculosis cases has gradually increased, so that, with the arrangements for all cases in
the hands of the Council, the most suitable accommodation for the individual patient is more readily
obtained and the number of cases waiting for beds has been substantially reduced.
Reference has been made to the shortage of bed accommodation, during and after the period of
the war, for the treatment of tuberculosis. During the war the greatest possible effort was exerted to
obtain accommodation for cases for which the Council was responsible, and these efforts were continued
after the war without relaxation. Owing largely to the assistance given by the Metropolitan Asylums
Board to meet the Council's needs, the position with regard to the available accommodation was much
improved during the vear.