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226 Annual Report of the London County Council, 1913.
Other schemes were forwarded by the Local Government Board to the Council for its observations.
It was, therefore, not clear what position the Council was to occupy in relation to those local schemes
and a request was made that the Board express its views on the subject.
Pending the elucidation of the position, the Council laid down the following broad principles
which should be observed in devising local dispensary schemes:—
(1) All possible use should be made of existing institutions.
(2) Approval should not be given to any scheme which fails to provide for each dispensary
being linked up with a hospital, to which special cases shall be referred for consultation or treatment,
residential or otherwise.
The reply of the Local Government Board to the Council's inquiry was to the following effect:—
(1) The Board retained the views expressed in its letter of the 11th December, 1912, and
considered that the Council should be the tuberculosis authority for London, and that through
the Council all agencies should be properly co-ordinated so as to form parts of a complete scheme.
(2) It was essential that the dispensaries should be closely related to the preventive
work which it is the duty of the local sanitary authority to carry out, and the Board acted on
the view suggested by the Departmental Committee in inviting the borough councils to provide
or arrange for the provision of dispensaries.
(3) The Board agreed with the view of the Council that all possible use should be made
of existing institutions and observed that in its opinion hospitals and other voluntary institutions
proposed to be recognised should be willing to work in close co-operation with the local
authority.
(4) The Board would welcome any suggestion which the Council might be able to mako
for securing greater efficiency in the dispensary work and agreed with the Council that, as far
as practicable, specially difficult cases should be referred from the dispensary to a general or
special hospital.
(5) The Board would be glad to learn what general rules the Council would suggest to
secure that the dispensaries should form part of the whole scheme for London.
(6) As to residential accommodation, the Board considered that upon the Council should
rest the responsibility of securing accommodation, both for insured and uninsured persons.
(7) The Board suggested the appointment of a Chief Clinical Tuberculosis Officer who
should also act as medical adviser to the Insurance Committee.
(8) The Board thought it desirable that the cost of the scheme should, at any rate, to a large
extent, be borne by London as a whole, but that as dispensaries were to be provided locally,
some proportion of the cost should be charged locally.
(9) With regard to insured persons, the Board considered that it would simplify matters and
enable one agreement to be made by the Insurance Committee in regard to all services rendered
to insured persons if the Council were recognised as the providing authority for all institutional
treatment.
On receipt of this reply the Council passed the following resolution:—
That any comprehensive scheme for dealing with the treatment of tuberculosis in London
shall provide for a contribution being made by the Council from year to year towards so much
of the cost of the dispensary treatment of uninsured persons in the City of London and each
metropolitan borough as would otherwise fall on the local rate, after taking into account the
promised grant from the Imperial exchequer, provided that such contribution (1) shall not
exceed 50 per cent. of such cost, (2) shall in the first instance be made from a date to be fixed
hereafter by the Council, and (3) shall be conditional upon the Council being satisfied with the
local scheme in force in such area and upon the arrangements and expenditure being annually
submitted to and approved by the Council; and that whilst by the above proposals ample funds
will be provided to meet the cost of dispensary treatment for uninsured persons, in view of the
fact that the Insurance Committee for the County of London have resolved that representations
should be made to the Treasury as to the inadequacy of the sums available for defraying the
expenses of sanatorium benefit in respect of insured persons suffering from tuberculosis in the
County of London, the Council is of the opinion that no comprehensive scheme can be adequately
carried out unless provision is made for meeting the full cost of the treatment of insured persons
out of the Insurance Fund or by the Government.
The Council thereupon proceeded to consider the schemes of the metropolitan borough councils
which had been submitted for its consideration. In the first instance, however, it was thought desirable
that general principles upon which the Council would be prepared to grant financial assistance
to local dispensary schemes should be laid down and it therefore decided
(i.) The Council must be satisfied that the premises to be utilised as a dispensary
are suitable for the purpose.
(ii.) The scheme must include provision, either in the dispensary, or at a hospital
working in connection with the dispensary, for the diagnosis not only of ordinary straightforward
cases, but also of incipient, anomalous and difficult cases specially referred on
the ground of difficulty of diagnosis.
(iii.) The physician in charge of the dispensary (or "tuberculosis officer") must
be a man of experience, not only in dealing with tuberculous affections, but also in general
medicine.
(iv.) Proper records and statistics in connection with the work of the dispensary
shall be provided of the nature and in the form required by the Council and approved
by the Local Government Board.