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Public Health.
" That for the provision of the additional sanatorium beds for adults required at the
outset, capital grants should be made up to three-fifths of the cost per bed, provided that the
total sum does not exceed an average of £90 per bed."
" That grants should be made for beds other than sanatorium beds."
" That schemes dealing with the whole population should be drawn up by the councils
of counties and county boroughs, or by combinations of these bodies, at the earliest possible
date, on the lines recommended in the report, with due regard to the incidence of the disease
and the special conditions and circumstances of the area."
" That the early establishment in working order of an adequate number of tuberculosis
dispensaries is essential."
" That so far as possible grants in aid of tuberculosis dispensaries should only be given
when such institutions will eventually form constituent parts of complete schemes."
" That, in framing complete schemes, regard should be had to all the existing available
authorities, organisations and institutions with a view to avoiding waste by overlapping, and
to obtaining their co-operation and inclusion within the schemes proposed."
" That special regard should be given to securing the co-operation of medical practitioners
in the working of the schemes, particularly in the relation to the early detection of the disease
and its domiciliary and dispensary treatment."
" That special attention should be paid to securing suitably qualified and experienced
medical practitioners for the senior appointments in connection with institutions established,
as the ultimate result obtained by the treatment recommended must depend to a great extent
upon their medical and administrative qualifications."
" That in erecting or adapting institutions, local authorities and other bodies should avoid
pretentious and extravagant buildings, and should aim rather at providing institutions of a
simple and inexpensive character."
" That, as regards London, it should be considered whether some of the sanatoria and
hospitals required should not be provided by the Metropolitan Asylums Board, and whether
dispensaries should not be provided by the metropolitan borough councils."
The Local Government Board in a circular letter, dated 14th May, 1912, called attention to the
report of the departmental committee, and stated that it agreed generally with the findings of the
committee, including the financial recommendations in regard to the distribution of the capital grant.
The Board suggested that the council of each county and county borough should forthwith take the
matter into serious consideration, and, by conference and consultation with the other councils, determine
what action they should take.
The circular letter above referred to was not addressed to the Council, but was sent to other
county councils, the councils of boroughs (including the metropolitan boroughs) and urban and rural
district councils. It was followed by a further circular letter, dated 6th July, 1912, dealing with provisional
arrangements for the treatment of insured persons recommended for sanatorium benefit, and
urging that complete schemes relating to the whole population, and not only to insured persons, should
be prepared in conference with the insurance committees and sanitary authorities, the unit area for
such schemes to be generally the county or county borough.
At the beginning of August, 1912, it was intimated that the Government would contribute annually
a sum, representing approximately half the total estimated cost of treating non-insured persons
as well as the dependents of insured persons. This sum would be distributed to local authorities which
undertook schemes, to be approved by the respective local government boards, for the general treatment
of tuberculosis in the areas under their jurisdiction.
On 27th July, 1912, a circular letter was sent by the Board to county councils, sanitary
authorities and insurance committees in England and Wales relative to the domiciliary treatment of
insured tuberculous persons. In the meantime no communication had been addressed by the Local
Government Board to the Council, and no indication had been given as to what authority was to be
responsible for dealing with the disease in London.
On 19th October, 1912, a letter was received from the Local Government Board stating that
the proposal of the departmental committee that the Metropolitan Asylums Board should provide
institutions for the treatment of tuberculosis could not be carried out owing to the fact that, under
the National Insurance Act, they were prohibited, as a poor law authority, from entering into arrangements
with the Insurance Committee with regard to the treatment of insured persons. The Local
Government Board, therefore, suggested that the Council should act in the matter. Further correspondence
followed and on 11th December, 1912, a letter was received, in which the Board suggested
that the Council should prepare a complete scheme for dealing with the disease in London. The Board
also referred to the fact that it had invited metropolitan borough councils to provide or arrange for
the provision of dispensaries, and stated that, in its opinion, the Council should provide or arrange
for the provision of residential institutions, and should be the central organising body for the provision
of institutional treatment, whether indoor or outdoor.
These letters were under careful consideration at the close of the year.
Although time did not permit of any decision being arrived at as to the permanent arrangements
to be made for the treatment of tuberculosis, the Council recognised the urgency of making available
for insured persons certain accommodation belonging to the Metropolitan Asylums Board which was
understood to be vacant, but which the Insurance Committee for London were unable to obtain owing
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