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Public Health. 225
The Council gave much attention during the year to the question of the treatment of tuberculosis
in London. Particulars were given in the last annual report* of the preliminary consideration by the
Council of the circumstances arising out of the provision contained in the National Insurance Act, 1911,
relative to the treatment of tuberculous persons who were either persons insured under that Act or
their dependents, and reference was also made to the temporary arrangements made with the Metropolitan
Asylums Board for the provision of residential accommodation for insured persons.
The Council was in doubt as to the position which it was intended to occupy in connection with
the treatment of tuberculosis in London, and the question was necessarily one of some difficulty owing
to the number of authorities and others in London who were concerned. The Local Government Board,
however, in a letter dated 11th December, 1912, stated inter a'ia that, with regard to dispensaries the
Board acted on the view, expressed in the report of the Departmental Committee, that the unit should
be the metropolitan borough or a combination of boroughs, and added that it had invited the borough
councils to provide or arrange for the provision of these institutions. At the same time the Board
stated that it was of opinion that the Council should formulate a complete scheme for London so that
the work which it was proposed should be done locally through dispensaries might be properly related
to the whole scheme, and for this purpose the Board desired to look to the Council to be the central
organising body for the provision of institutional treatment whether indoor or outdoor.
As the result the Council instructed the Public Health Committee to prepare forthwith and to
submit to it a scheme for dealing with tuberculosis throughout the administrative County of London.
In compliance with this instruction the Committee first considered as to the appropriate means
of providing sanatoria and other residential institutions, and concluded that the Council could best
discharge its duties as health authority for London by co-ordinating the arrangements for the treatment
of tuberculosis throughout the county, but that in order to do so it did not necessarily follow
that it should itself become an active treating authority. In this connection the Committee suggested
the possibility of removing the disabilities attaching to the Metropolitan Asylums Board as a poor
law authority and of enlarging the scope of its activities so as to enable it to provide for the residential
treatment of both insured and uninsured persons suffering from consumption, and with this object
they made the following recommendation which was adopted by the Council:—
"That in order to allow of a comprehensive scheme for the treatment of tuberculosis
in London, and in view of the fact that the Council has hitherto not been an authority providing
treatment for tuberculous persons, and that the Metropolitan Asylums Board has available
the machinery necessary for the provision of residential treatment, it is essential that the Board
should be enabled to become an authority providing institutions for residential treatment for
tuberculous persons of all classes."
The disabilities attaching to the Metropolitan Asylums Board in respect of insured persons
were removed by Section 39 of the National Insurance Act, 1913, which provides that, with the
sanction of the Local Government Board, the managers of the Metropolian Asylums district may "enter
into agreement with any county council or county borough council, or, with the consent of the county
council, with any authority in a county, for the reception of insured persons or their dependants
suffering from tuberculosis or any such other disease as the Local Government Board, with the
approval of the Treasury, may appoint under section eight of the principal Act, into hospitals or
sanatoria provided by the managers "
This Act came into operation on 1st September, 1913, and the Council gave its consent to direct
arrangements being made by the London Insurance Committee with the Metropolitan Asylums Board
for the treatment in the Board's institutions of insured persons suffering from tuberculosis.
The position of the Council in the matter of making provision for tuberculosis treatment was
strengthened by the Public Health (Prevention and Treatment of Disease) Act, 1913, which received
the Royal Assent on 15th August of that year. Clause 3 of this Act provides that, "it shall be lawful
for the Council of any county or for any sanitary authority to make any such arrangements as may
be sanctioned by the Local Government Board for the treatment of tuberculosis ; provided that the
power conferred by this section shall be in addition to and not in derogation of any other power."
Pending the passing of the foregoing legislation, the Public Health Committee proceeded, as far
as possible, with their inquries and with the consideration of matters connected with the formation
of a complete scheme for London. The position to be occupied by the hospitals and their relationship
to the dispensaries was considered and it was deemed essential that each dispensary should be linked
with a hospital in order that the dispensaries might have the advantage of the help of the consultant
staff and of the bacteriological and other equipment of the hospitals for dealing with difficult cases.
The Committee further proceeded to consider the distribution of existing institutions, including
dispensaries and hospitals, with a view to ascertaining how far the available accommodation could be used
and how best the linking of existing dispensaries with hospitals could be effected and the extent to
which new dispensaries and residential institutions would be necessary. Various inquiries were made
with this object and a number of proposals were under the consideration of the Committee.
During this time the Local Government Board had been in communication with some of the
borough councils respecting dispensary schemes prepared by them and in some cases the arrangements
of the borough councils had been approved. The sanction of the Board, however, contained the following
paragraph:—
"In order that the dispensary arrangements proposed may be properly related to the
arrangements for London as a whole, the Board would suggest that before finally adopting a
scheme for the borough, the council should consult the London County Council on the matter."
* Annual Report of the London County Council, 1912. Vol. III., pp. 216-218.
23610 GG
Treatment
of
tuberculosis.