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TUBERCULOSIS. 43
Of the 83 patients whose "housing" was noted, 12 (13.6 per cent.) were found in basement
homes, and 49 (55.6 per cent.) on the first or higher floors. It would be desirable, were it
possible, to trace back the housing histories of the patients to determine the frequency of basement
homes among cases of tuberculosis. It is, however, possible to hazard the surmise that as
many of the patients were at the time of the inquiries not "so well off" by reason of their
illness, they were probably better housed in the past, and therefore less likely to have occupied
basements. In the examination of the records of removals (which have not been kept in the
past with as much detail as could be wished), it has been noted that many of the patients moved
upstairs and not down.
Failures to notify.-A strict compliance with the Regulations of 1911 should have resulted
in the Department knowing all the cases ending fatally during the year in the lives of the
patients, the only exception allowed by the Regulations then in force being cases in lunatic
asylums. In addition to the 5 unreported fatal cases in lunatic asylums, there were 6 others
during the year, viz., 2 among those dying at their homes, 1 at the Infirmary, and 3 in outlying
institutions-facts which may fairly be regarded as evidence of the satisfactory working of the
Regulations.
National Insurance Act, 1911.-The "Sanatorium Benefit" provisions of the Act
came into operation on July 15th of last year, but so far as was known to the Department, no
application was sent in from any insured person residing in the Borough until October. Every
effort was made to keep in touch with this part of the work of the County Insurance Committee,
but it is certain that a number of applications were sent in to the Insurance Committee which
did not come to the knowledge of the Department. Supplies of application forms-"Med. 1"
and "Med. 2"-were received for distribution, and, whenever possible, the forms were sent to
the Insurance Committee through the Department and records kept of the dates of transmission
of the forms and of the subsequent progress of each case. During the last quarter of
the year nearly all the local work of administering the benefit was carried on through the
Department. A "Local Sub.Committee" was appointed and met for the first time on
September 16th. A provisional scheme for "domiciliary treatment" was drawn up by the
Medical Officer of Health (who was an ex officio member of the Committee) and adopted by
the Sub.Committee on November 25th. The scheme remained in operation until January 15th
of this year.
It should be explained that "Sanatorium Benefit" may be given in one of the following four
forms, viz.-Residence in a sanatorium, treatment at a hospital (in. or out.patient), treatment at
a dispensary for tuberculosis, and treatment at the patient's home ("domiciliary treatment").
Each patient has to make application for the benefit, and to send in a medical certificate from his
own medical attendant, who is subsequently asked to report at length on the case. Each patient
has to be seen by the Committee's Referee, who submits his report on the case and makes his
recommendation as to the form of benefit which the case needs. Up to the end of the year no
attempt appears to have been made to take the patient's home surroundings into consideration
when settling the form of benefit to be granted.
The applications known to have been sent in from the Borough up to December 31st last
numbered 31. Two patients withdrew their applications, and 4 were found to be ineligible,
as they were not suffering from pulmonary tuberculosis-the only form of the disease for which
any provision was being made by the Insurance Committee. One patient left the Borough
before his application was dealt with, and another was sent away privately after a somewhat
lengthy wait for the " benefit." Of the remaining 23 patients, 13 were granted treatment in
sanatoria ; 4 in hospitals ; 2 at dispensaries, and 4 at home. At the request of the Insurance
Committee the Medical Officer of Health made the necessary arrangements for treatment at
home, and at the Paddington and Kensington Dispensary, both of patients to whom dispensary