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Report of the County Medical Officer—General. 75
referred to the fact "that the Local Government Board had addressed circular letters, dated 14th
May and 1st July, 1912, to the councils of all counties, except London and to county boroughs, and that
these letters laid special stress upon the necessity for the organisation, by those councils, of complete
schemes for the treatment, within the areas under their administration, of all tuberculous persons."
In order that provision for insured persons should not be delayed the Council, without waiting
for the settlement of the question of the Council's general position, opened negotiations with the
London Insurance Committee and the Metropolitan Asylums Board with a view to the temporary
accommodation of insured persons in existing institutions belonging to the last-named authority.
The Council was consequently in a position on 17th December, 1912 (p. 1,673) to receive the provisional
grant of £10 offered by the Treasury, the acceptance of which was necessary before any expenditure
could be incurred by the Council, and to approve arrangements which had been accepted by the
Metropolitan Asylums Board and the London Insurance Committee for the provision of accommodation
in the institutions of the Metropolitan Asylums Board for the treatment of insured persons suffering
from tuberculosis. At the time the foregoing arrangements were agreed upon between representatives
of the parties, it was hoped that the Metropolitan Asylums Board would be able to provide accommodation
for 500 persons in one institution. Subsequently, however, the Metropolitan Asylums Board found
themselves unable to do this and submitted amended proposals providing 300 beds for men at Downs
Sanatorium, Sutton, Surrey, and 200 beds at the Northern Hospital, Winchmore Hill. Accommodation
was available at Downs Sanatorium on 10th February and the numbers were gradually increased until
the full accommodation for 300 men was completed on 22nd May, 1913. Sanatorium beds for 100
women and 100 beds for observation or hospital cases (men and women) were provided at the N orthern
Hospital, Winchmore Hill; of the latter cases 75 beds were for men and 25 for women. Later the
distribution of accommodation was varied so as to provide for 250 men (sanatorium cases) and 50 men
(hospital cases) at Downs Sanatorium, and 150 women (sanatorium cases), 25 men (hospital cases) and
25 women (hospital cases) at the Northern Hospital. Admissions to the Northern Hospital commenced
on 3rd March, 1913.

During the course of the year enactments were passed removing the disability of the Metropolitan
Asylums Board, as a poor law authority, in dealing directly with the Insurance Committee, and extending
the powers of county councils and sanitary authorities for making arrangements for the treatment
of tuberculosis. Having regard to these new powers, the Council agreed to the termination on 31st
March, 1914, of the temporary agreement among the London County Council, the London Insurance
Committee and the Metropolitan Asylums Board.
The preliminaries towards framing a complete scheme for London are fully described in Chapter
XXXIII. of this volume. It will here be sufficient to note that some of the borough councils had
already prepared dispensary schemes in connection with their own areas, and some correspondence was
involved in relating these schemes to the general scheme for the county as a whole. In this way a
number of individual schemes were reviewed, and it was possible before the end of the year for the
Council to give a qualified approval in two instances, viz :—Southwark and Chelsea.
Briefly stated, the London scheme as foreshadowed by resolutions during the year, comprehends
the provision and maintenance of dispensaries by the borough and city councils, aided by grants from
the County Council and the provision of residential treatment.
The arrangements made by the Metropolitan Asylums Board with the Insurance Committee for
the residential treatment of insured persons left the question of such provision for uninsured persons to
be dealt with by the Council.
Much difficulty w as felt in deciding as to the accommodation required in the absence of reliable
data, especially in view of the exceptionally favourable position of London in respect of well-equipped
institutions for the care of the sick. Taking into consideration the hospital provision in London and
23610 L 2