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136
amount they are alone responsible. It is clear, therefore, that
estimates as to cost, based upon the grant originally mentioned,
must be revised in the light of the altered circumstances, and that
these altered circumstances are responsible for a large sum
from the local rates being necessary to provide for the treatment
of persons who should have been paid for out of insurance funds.
In my last report I offered some criticism upon the provision
of "sanatorium benefit" made under the National Insurance Act.
I suggested that the income of the Local Insurance Committee was
not likely to prove sufficient to include the dependents of insured
persons, and that the number of different and independent agencies
concerned in the handling of tuberculosis individuals, each acting
more or less independently of the other, was a weak point in our
administration. The work of the past year shows an increasing
demand for sanatorium treatment amongst the people, a demand
which the Act has created and which the authorities are unable
at present to supply; and the London Insurance Committee has
been severely hampered by lack of funds.
The organisation of the treatment of tuberculosis in London
is still far from satisfactory, and progress is very slow. Both the
London County Council and the Local Government Board have
expressed the opinion that, so far as possible, the large general
and special hospitals should be utilised. The advantages they
can offer in the way of experienced staff, special departments,
clinical laboratories, and beds for observation, exceed in their
completeness any provisions that can be made by local authorities
in the shape of dispensaries. The dispensary physician gives such
information to the Borough Medical Officer as may be required,
and he receives from the Borough Medical Officer such information
as he desires and as may be arranged for.
But apart from the provision of dispensaries, the need of
many hospital beds for advanced, emergency, observational, educational
and surgical cases is very great. These may be provided
in separate pavilions at isolation hospitals in conveniently accessible
sanatoria or in special hospitals, while arrangements may be
made with general hospitals for receiving operative and other
special cases.