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others special services for tuberculous persons have been arranged at dental clinics established in connection
with other branches of public medical work, (e.g , maternity and child welfare), and, in the case of
tuberculosis dispensaries at hospitals, the facilities available in the dental departments have been used.
In one case a firm of private dentists have undertaken the work in the tuberculosis dispensary which has
been equipped for the purpose. Generally stoppings and fillings are provided without charge to the
patients, but payments are expected for dentures according to the financial circumstances of the patients.
Two methods of payment to the authorities undertaking the work are in operation, (1) payment
on the capitation basis and, (2) by means of a block grant. There are objections to the capitation payment
system, but the experience gained will be of assistance in fixing a reasonable block payment rate.
This work is regarded as being in the experimental stage, and is under special observation. The whole
position will be reviewed in 1921, and it is hoped that it will then be possible to draw up a uniform scheme
for the whole of London.
In an appendix III. a statistical statement is given indicating the work done at the dispensaries in
London during 1920.
An important feature of the dispensary service has been the linking up the charitable, and other
agencies for social service with the dispensary so as to secure extra assistance, such as additional food,
clothing, improved home conditions, and, in some cases changes of occupation, which are frequently
necessary if the patients are to benefit from the treatment provided for them. It was contemplated that
borough committees would be appointed which would include in their membership representatives of all
such agencies in the borough. Six borough committees have been appointed, one of them being a joint
committee serving two boroughs; and twenty of the remaining boroughs are served by twenty-two
interim tuberculosis care committees appointed by the Council to do the work until borough committees
can be appointed. In the borough of Lambeth the work is done partly by a social worker in the public
health department of the borough council, and partly by the Lady Almoner of St. Thomas's Hospital,
in co-operation with the social welfare agencies of the borough. The City of London has a dispensary
service of its own.
The existing committees are frequently able to persuade parents, who hesitate to part with their
children, of the advantages of institutional treatment, and to remove difficulties in the case of women
patients by arranging for the care of children during absence of the mothers. It is a very common thing
for reports to be received in the public health department that the care committees have been able to
arrange for separate beds for patients who have hitherto shared a bed with others, and to effect other
improvements in hygienic conditions. The reasonableness of the assessments recommended by the care
committees, for giving effect to the provision in the Council's tuberculosis scheme that a charge should be
made roughly equivalent to the cost of keeping the child at home, is demonstrated by the fact that, apart
from revision due to change of financial circumstances, the amount which has had finally to be written
off as irrecoverable has been comparatively small.
In December, 1918, the Council decided to supplement the tuberculosis scheme by the provision
of open air schools for children who have been "notified" under the Tuberculosis Regulations, 1912,
as definitely tuberculous. These schools, on the one hand, obviate the necessity of sending to sanatoria
children who are unfit for an ordinary public elementary school, but who do not need sanatorium treatment—and
on the other hand, reduce the risk of breakdown in children after treatment in sanatoria
resulting from too sudden change from the open air conditions of the sanatorium to those of ordinary
life. The types considered suitable for the schools are early lung cases more or less quiescent and gland
cases in which there are no discharging sinuses. One such school, Kensal House, having accommodation
for 90 children, was opened in 1910 as a voluntary institution, but was later transferred to the Council.
Two similar schools, Stormont House, Hackney, and Springwell House, Clapham Common, were opened
by the Council in September, and October, 1919, respectively, the former having accommodation for
75 children, and the latter for 125 children. In addition to these, as a temporary expedient, two Central
Fund Dispensaries—Camberwell and Fulham—have provided classes for 25 each, the first at a house in
Grange Hill-road, Denmark Hill, and the second in the garden of the dispensary in New King's-road,
Fulham. The Council in each case has provided the teacher and educational equipment. The Fulham
School is shortly to be replaced by a school for 50 children to be established by the Council at the Elizabethan
Schools, Broomhouse-lane, Fulham.
The Council's Open Air Schools have been established under the provisions of the Elementary
Education (Epileptic and Defective Children), Act, 1899, and the work will accordingly be referred to in
the section of this report dealing with the school medical service.
With regard to residential treatment much has been written during the year on the question
whether or not " sanatorium " treatment is an effective means of treating pulmonary tuberculosis. In
the report already referred to, dealing with the survey of the arrangements in operation in London for
the control and treatment of this disease, results were given of enquiries made by Dr. Bardswell, then
medical adviser of the London Insurance Committee, supplemented by particulars relating to uninsured
persons, as to the condition of a limited number of patients at the end of four years after their discharge
from residential institutions. These results indicated a very high percentage of deaths. Similar
enquiries in other parts of the country gave practically the same results and the conclusion was thereupon
drawn that sanatorium treatment was a failure. The examination of the figures in detail shows clearly
that there has been considerable misconception of the meaning of the term "sanatorium treatment,"
not only by the lay public, but also by medical men, and, further, that in more than 50 per cent, of the
cases sent to sanatoria the disease was too advanced for sanatorium treatment, properly understood, to
be of permanent benefit to the patients.
These experiences have indicated the need for improvement in the direction of (i.) providing
machinery of detecting the disease in the early stage at which sanatorium treatment has been
Tuberculosis
care
committees
Open air
schools for
tuberculous
children
Residential
treatment for
tuberculosis