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realised that the extension of notification to all forms of tuberculosis encourages the belief that all forms
of tuberculosis will be treated in sanatoria, but obviously only certain carefully selected cases of pulmonary
tuberculosis should be so treated. It will require the closest attention of medical officers
working on clearly defined lines to ensure equality of treatment throughout London.
I commend attention to two difficult points, viz. (1) Rest Homes ; (2) Care of the Teeth.
(1) Great difficulty is experienced in finding beds for hopeless cases, nor is it desirable that
generally speaking, these cases should be mixed with the more hopeful cases. I deprecate the
term " Homes for the dying," but it is probable that a certain number of beds will need to be
provided locally, situated in " Rest Homes."
(2) Tubercular patients frequently have bad or neglected teeth. All persons intended for
sanatorium treatment should have their teeth attended to, with a view to removing one of the
main obstacles to improved nutrition.
(b) Uninsured persons.—This term includes dependents of insured persons, but I consider it
advisable to distinguish children from adults in the scheme, in view of the fact that the Education
Authority has statutory relations with regard to this class of dependents. In all treatment of uninsured
persons carried out locally, the local rates should bear a percentage of the cost, and, if, as is proposed
by the Government, half is borne by the State, this proportion should be not less than a quarter;
the county rate finding the remainder.
With regard to adults, I see no reason why, if unable to pay for themselves, they should not be
dealt with as at present, when suffering from certain other infectious diseases, that is to say, by admitting
to suitable institutions such as are provided by the Metropolitan Asylums Board, or are found in the
voluntary hospitals. It is worthy of consideration whether voluntary hospitals could in any cases
by means of the proposed capital government grants under the National Insurance Act, extend their
existing accommodation. Evidently the same reservations as to who should undergo institutional
treatment, must be enforced as in the case of insured persons, but I consider that it is essential that
local authorities should not find it more economical to give treatment in residential institutions rather
than elsewhere. I therefore would propose that, as regards the Metropolitan Asylums Board, the Local
Government Board be asked to make such rules as would enable a moietyof the expenses falling on the
rates, to be met locally.
Part III.—Children.—The London County Council, as education authority, at present deals
with the health of children, and has already provided and maintains a few institutions and open air
classes for tuberculous children.
I should like to see sanatorium provision where education is also given, to accommodate some 500
children ; I believe this to be essential. Of these, some 350 would be surgical cases and 150 other forms.
As prevention is better than cure, open air classes should be developed everywhere, and be brought
into association with dispensaries. I contemplate classes of children who are tuberculous or come from
homes where tuberculosis exists, being medically provided for, in association with the dispensary.
Educationally, of course, the London County Council would be responsible.
The borough medical officer of health will thus have a much greater responsibility as well as
a greater opportunity as regards children living in contact with tuberculous persons.
It is inadvisable to prolong this memorandum, although there are many details to which I have
not referred, but those who read the letter of the Local Government Board, which was addressed on 11th
December, 1912, to the County Council and published in the report of the County Council of the 17th
December, 1912, and who have followed the various documents issued by the Local Government Board
will be able to supply the gaps in this necessarily imperfect outline, which I desire to place on record,
and I shall welcome criticisms and suggestions in the hope that a suitable solution shall be found of
what is a very difficult problem.
Cecil B. Levita.
County Hall,
Spring Gardens,
22nd February, 1913.