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37
During the past decade there had appeared to be a noticeable check in that decline in
mortality from tuberculosis which had been proceeding for half a century, and during the war
years there had even been a small increase in the annual figures. These manifestations, taken
in conjunction with "the active work which had been done during the past ten years in the
direct campaign against the disease (compulsory notification, home visitation, work of the
tuberculosis dispensaries, sanatorium treatment, etc.), were somewhat disappointing; and it is
reassuring to observe that during 1919 and 1920 the decline in mortality has been renewed.
So much so is this the case that the number of deaths from all forms of tuberculosis in
1920 (312) was 31 per cent, less than the corresponding average annual figure for the five war
years (1914-1918).
The St. Pancras Tuberculosis Scheme.
Emphasis has been laid in previous annual reports on the division of responsibility for
anti-tuberculosis work between different authorities.
(1) The Borough Council was originally the only local authority concerned, is still
responsible by reason of the fact that all cases of tuberculosis are compulsorily
notifiable to its Medical Officer of Health, and that it provides the tuberculosis
dispensaries and appoints and pays the tuberculosis officers and tuberculosis
visitors.
(2) The London County Council arranges for the institutional treatment of tuberculous
persons (chiefly through other bodies), and, to a great extent, controls the policy
to be followed in connection with the admission of cases to sanatoria and other
institutions and their after-care. The effect of this is that the work of the tuberculosis
officers is very largely controlled by the County Council, though, at the
same time, he is the Borough Council's officer and administratively an integral part
of the Borough Medical Officer of Health's Department.
(3) Other authorities are also closely concerned. The London Insurance Committee
continued in 1920 to be responsible for the institutional treatment of insured
persons, but this responsibility has since been transferred to the London County
Council. The Board of Guardians fulfil a very important function in the provision
of beds, chiefly for advanced cases, in the Poor Law hospitals. The
Metropolitan Asylums Board also plays an important part in the matter by the
provision and maintenance of sanatoria and hospitals.
As the result of this splitting of responsibility, the Borough Council and its Medical
Officer of Health are not the controlling agents in the development and administration of the
anti-tuberculosis work, and have, to a great extent, to shape their actions in order to conform
with the policy of the other authorities.
Visiting Work.—The home visiting of notifledand other cases of tuberculosis, and contacts,
has been carried out by certain of the women inspectors working from the Town Hall, and by
the nurses at the tuberculosis dispensaries. The papers in connection with all notified
cases are filed at the Town Hall, and clinical and other records of those cases which pass
through the hands of the tuberculosis officers are kept at the dispensaries. At the Town Hall
Miss Bibby undertakes co-ordinating and advisory work in connection with tuberculosis, and
Miss lilaxland and Miss Parnell are responsible for tuberculosis home visiting, to which they
give part of their time. There is one nurse at the St. Pancras Dispensary (and its branch) who
devotes to home visiting such of her time as is available for that purpose, and one nurse
(part-time so far as St. Pancras is concerned) at the University College Hospital Dispensary.