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41
Treatment of Tuberculosis.
In the report of the Medical Officer of Health for 1912 was included a
report by the Chief Clerk (Mr. A. Powel Coke) upon the administrative measures
in St. Pancras in relation to tuberculosis. This gives a full account of the scheme
for treatment in the Borough up to April, 1913, with special reference to the
National Insurance Act.
Before the inception of the National Insurance Act, 1911, a number of
local sanitary authorities had undertaken, at the expense of the rates, the
treatment of tuberculosis, either by the provision and maintenance of Sanatoriums,
or by paying for the treatment of patients in private Sanatorium.
Some local authorities and voluntary societies had also established out-patient
treatment on lines which foreshadowed the tuberculosis dispensaries of the
Astor report.
"With the advent of the Insurance Act, and its "Sanatorium benefit,"
attention was concentrated upon this disease, and during 1912 the Report of
the Departmental Committee on Tuberculosis laid down certain considerations
of general policy in regard to it. They recommended that every district should
be provided with (1) a tuberculosis dispensary, with an expert consulting
officer, and (2) resident institutions, such as sanatoriums and hospitals. In
the case of London they suggested that it should be considered whether the
resident institutions should not be provided by the Metropolitan Asylums
Board and the dispensaries by the Borough Councils.
The report also emphasised the point that any scheme ought to provide for
the non-insured as well as the insured; and the Local Government Board
later made it clear that in addition to capital grants towards the provision of
institutions they were prepared to make annual maintenance grants to local
-authorities to the extent of one-half of the expense incurred after the deduction
of the maintenance contribution made by the local Insurance Committees.
Until towards the end of the year (1913) it appeared to be somewhat doubtful
whether the County Council or the Borough Council were to be the providing
authority for the treatment of tuberculosis. On the one hand the
Borough Council was the authority under the Public Health (Tuberculosis)
Regulations, and had been invited by the Local Government Board to provide
or arrange for the provision of dispensaries, and on the other hand the County
was the unit for insurance purposes.
It was later decided that the provision of residential institutions should be
arranged for by the County Council, and that of dispensaries by the Borough
'Council, and that the County Council should contribute towards the cost of
dispensaries, exercise a certain measure of control over them, and be the coordinating
authority for tuberculosis in London.
This was made clear by the letters of the Local Government Board addressed
to the County Council on the 24th September, 1913, and to the Borough
Councils on the 19th December, 1913, and the resolutions of the County
Council of the 4th November.