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71
The Borough Council addressed a communication to the London Insurance
'Committee, drawing attention to the small number of cases sent by that
Committee to the Dispensary.
Insured Patients.
Persons insured under the National Insurance Act were permitted to
apply for Sanatorium Benefit immediately after the Act came into force.
During the latter part of the year 1912, therefore, considerable time was
occupied both in dealing with individual cases of peculiar difficulty, and in
trying to organize some mode of co-ordinating the work of the local Insurance
Sub-Committee, of which the Medical Officer of Health, ex-officio, was a
member, with the work of the Public Health Department. Twenty-nine
special cases were dealt with by the Committee. During this period the
London Insurance Committee sent certain cases away to Sanatoria, and
decided to award to other cases treatment in their own homes. The cases dealt
with at home were usually referred to the Medical Officer of Health, who was
requested to arrange for the domiciliary treatment desired by the Committee.
In the hope of providing a model for true Sanatorium treatment at home
we devised, and in one case carried successfully into operation, a scheme
which it may bo of interest to place on record.
The scheme involved the close co-operation of the agents concerned in the
care of the tuberculous insured persons. It assumed that every local Medical
Practitioner treating an insured person was upon the Visiting Staff of the
Borough Dispensary, and that the Borough Dispensary was regarded as an
essential factor in the work of the Public Health Department. On receipt of
the request from the Insurance Committee to arrange domiciliary treatment,
the patient was visited by an Inspector of the Public Health Department to
ascertain what individual doctor was preferred by the patient, and what were
the patient's general circumstances and needs. The doctor selected by the
patient was then requested to undertake the care of the patient, and on
consenting to do so he drew up, usually in collaboration with the Inspector
to whom the case was known, a list of necessaries which he considered essential
to the patient's progress. This list, with an estimate of the probable cost, was
submitted by the Medical Officer of Health to the Insurance Committee. If
approved, the necessaries prescribed were obtained and supplied to the patient
through the Dispensary Nurse, who visited the patient daily to give any
nursing attention necessary, and to carry out any instructions of the doctor,
and who brought up to the Inspector, and if necessary to the Medical Officer
of Health, accounts, reports, and any special difficulties arising out of the
patient's condition or the general needs of the family. It was hoped, by the
establishment of an Invalid Kitchen, and by various frugal devices within the
powers of the Dispensary, to arrive in time at a thoroughly efficient mode of
treatment, at a very reasonable cost. The scheme worked perfectly in actual
fact, but owing to financial difficulties it had to be abandoned.