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76 Annual Report of the London County Council, 1913.
the sanatorium accommodation within a reasonable distance of London, it was, however, considered
that 160 hospital beds distributed in convenient localities in London and 240 sanatorium beds would
constitute a suitable initial provision for uninsured adults. These figures are exclusive of those advanced
cases which hitherto have largely found their way ultimately into poor law institutions and which present
a distinct problem having regard to the desirability of accommodation being found for them as near as
possible to their homes. If, as is probable, it should be found subsequently in actual experience that this
accommodation is insufficient for growing needs, the question of further accommodation can then be
considered.
In the case of children educational considerations and the different characteristics of the groups
of cases to be dealt with require to be borne in mind. The main groups are (1) those Buffering from
bone and joint tuberculosis, and (2) those suffering from pulmonary tuberculosis, (3) there is also
a third group suffering from tuberculosis of the skin, glands, and other organs to be considered. It
is possible to form some estimate of the dimensions of the problem of the first or surgical class owing
to the need for surgical interference having brought the cases to light, and the knowledge acquired
through the work of the Council as education authority in connection with its day schools for physically
defective children. The second or medical group is at present a very indeterminate quantity about
whose dimensions there is no general agreement. The problems connected with children are discussed
in the section of this report dealing with education. It will here suffice to mention that it is
estimated that the following accommodation already exists for dealing with children who while under
treatment can reside at home and at the same time be educated in day schools :—
(а) Surgical cases.—Day schools for physically defective children, 1,500.
(b) Medical cases.—Day open air schools, 300.
It is considered that, as a beginning, 500 beds should be acquired in residential institutions,
viz., 350 for surgical cases, and 150 for medical cases. Of the latter 125 should be for pulmonary
cases and 25 for glandular cases.
The Council, on 4th November, 1913 (p. 860), passed the following resolution:—
That any comprehensive scheme for dealing with the treatment of tuberculosis in London
shall provide that the Council shall make arrangements with the Metropolitan Asylums Board,
with hospitals and with sanatoria for the provision of residential accommodation required for
London uninsured patients suffering from tuberculosis, and that it be referred to the Public
Health Committee to consider and report whether adequate provision can be made in this
manner without the Council being called upon itself to own and manage institutions.
Since this date the Public Health Committee have been engaged in pursuing inquiries in various
directions with a view to ascertaining the extent to which residential hospital and sanatorium provision
would be necessary and the institutions through which it would be possible to obtain it. The
Central Fund for the Prevention of Consumption have given assistance to the Committee in supplying
particulars respecting their institutions, and figures have been obtained from the London Insurance
Committee. Replies have been received from a number of hospitals to which inquiries have been
addressed, from which it would appear that all the residential hospital accommodation likely to be
required for immediate use is obtainable and at the end of the year negotiations had been opened with
the hospitals and with sanatoria already established with a view to definite offers of accommodation
being made to the Council. The scheme for co-ordinating the work of the various agencies dealing
with the treatment of tuberculosis was only in draft at the end of 1913 and will be referred to in the
report for the ensuing year.
Health Visitors.
Under the provisions of section 6 of the London County Council (General Powers) Act, 1908,
any sanitary authority (including the City Corporation) may on or at any time after the first day of
January, 1909, appoint suitable women (to be known as health visitors) for the purpose of giving to
persons advice as to the proper nurture, care and management of young children and the promotion
of cleanliness and discharging such other duties (if any) as may be assigned to them in accordance
with the provisions of the section.
The section also authorised the Local Government Board to make regulations prescribing the
qualifications, mode of appointment, duties, salary and tenure of office of health visitors appointed
thereunder and provided that no appointment of a health visitor should be made otherwise than in
accordance with such regulations.
On 4th September, 1909, the Local Government Board issued an order, known as the Health
Visitors (London) Order, 1909, in which the qualifications, duties, etc., of these officers were defined.
By this order a woman is qualified for appointment as a health visitor if she—
(а) is a duly qualified medical practitioner within the meaning of the Medical Acts ; or
(b) is qualified for the appointment of nurse by having undergone, for three years at
least, a course of instruction in the medical and surgical wards of any hospital or infirmary,
being a training school for nurses, and having a resident physician or house surgeon ; or
(c) is certified under the Midwives Act, 1902 ; or
(d) has, for a period of not less than six months, undergone in a hospital or infirmary,
receiving children as well as adults, and having a resident physician or house surgeon, a course
of instruction including subjects relating to personal hygiene, and holds the certificate of the
Royal Sanitary Institute for Health Visitors and School Nurses, or the Certificate or diploma
of the National Health Society, or of any other body which may from time to time be approved
by the Local Government Board; or