View report page

12
Depletion of Sanitary Staffs.
The difficulties referred to in last year's Report as being still outstanding in two boroughs were
satisfactorily dealt with early in 1917. In the early part of the year the attention of the Local Government
Board was again drawn to difficulties experienced by several of the metropolitan borough councils
with regard to collection and disposal of house refuse due to the depletion of staffs, shortage of labour
and restricted transport facilities. In several instances the intervals between collections were as long
as four weeks, and accumulations of collected refuse remained on wharves or at railway sidings owing
to the absence of barges or scarcity of trucks. By midsummer considerable improvement had been
effected in the collection and disposal of house refuse throughout the metropolis.
National Insurance Acts 1911-13—Treatment of Tuberculosis.
The scheme for the treatment of tuberculosis in London adopted by the Council in May, 1914,
and the arrangements approved in June of the following year for the appointment of interim care committees
continued in operation during the year 1917. Shortly stated, this scheme places the responsibility
for dispensary treatment upon the borough councils, with financial assistance from the Council
to the extent of 25 per cent. of the cost of treatment of uninsured persons ; the Council further makes
at its own expense arrangements for the treatment in residential institutions of uninsured persons
by taking beds in voluntary hospitals and sanatoria, and it provides by arrangement with the Metropolitan
Asylums Board for the use of beds in their institutions, the cost of the latter being borne by
the Board. In the case of children treated in residential institutions, the parents are asked to pay
to the Council a small sum roughly representing the cost of the child's maintenance at home. In adult
cases free treatment is provided where the income does not exceed £160 a year. Where the income of
the patient or the person responsible for the patient's maintenance exceeds this amount a contribution
may be asked for towards the cost of treatment. The London Insurance Committee deals with insured
persons both in respect of dispensary treatment and treatment in residential institutions. Dispensary
treatment for insured persons is provided as part of the schemes of borough councils by agreement
between the London Insurance Committee and the respective borough councils. The use of the dispensary
at Victoria Park Chest Hospital (for the borough of Bethnal Green in addition to part of
Hackney commenced in October, 1917), brings the total number of schemes in operation, including that
of the City of London, to 27. The Stepney Borough Council have now completed an agreement for the
use of the three voluntary dispensaries which have been at work in this borough for some years. The
borough of Hammersmith has recently adopted a scheme for the provision of a tuberculosis dispensary.
When this scheme is in operation dispensary provision for the whole of London will have been made.
The total number of dispensaries at work at the end of 1917 was 37, some of the boroughs having
provided more than one dispensary.
A summary of the dispensary work during 1917 is given in the table on page 13.
With regard to the residential treatment of uninsured persons, the Council renewed authority
for the use of 231 children's beds and 100 adult beds in voluntary institutions and for the acceptance
of such beds as were available in the institutions of the Metropolitan Asylums Board, the latter including
a small number of beds for advanced cases, at St. George's Home (women) and at Downs Sanatorium
(men). At the end of May, 1918, the number of children's beds had been increased to 300. The total
number of cases treated during 1917, inclusive of those under treatment at the end of the previous year,
was 224 men, 446 women, 933 children.
In addition the Council continued, with certain administrative modifications, the scheme of
co-operation with the Invalid Children's Aid Association which commenced in November, 1915, under
which beds available, through them, in institutions are used principally for cases requiring " convalescence
" rather than treatment in sanatoria. These are, generally speaking, gland cases, surgical
cases requiring open-air life and surgical dressings following operations, and children requiring convalescence
after sanatorium treatment. Some 400 beds were obtained in this way and more than 1,000
children benefitted. The agreement with the Invalid Children's Aid Association also includes financial
assistance in the provision of surgical instruments and other accessories to treatment and after care of
children dealt with in hospitals and sanatoria at the instance of the Council.
The Council continues to receive the active co-operation of the 29 interim tuberculosis care
committees appointed by t he Council throughout London, pending the appointment by the Metropolitan
Borough Councils of borough carc committees, constituted in accordance with the model scheme adopted
by the Council on the 15th June, 1915; the Borough of Chelsea is the only borough at present which
has appointed its own committee representative of the various local agencies in the borough. The
interim care committees are principally concerned with the home life of the patients and with obtaining
for them extra nourishment and suitable employment. They are frequently able to influence patients who
would otherwise refuse to do so, to attend regularly at the dispensaries or to undergo treatment in
residential institutions; this is particularly the case in respect of parents who are loath to part with
their children for the long periods necessary for effective sanatorium treatment. They also visit the
homes and ensure that parents understand the instructions given to them as to arrangements for
institutional treatment. In quite a large number of cases the "after care" reports indicate that
considerable improvement has been effected in home conditions as the direct result of the activities of
the interim tuberculosis care committees. Children who, prior to treatment, slept with others, are
provided on return with separate beds and even separate bedrooms. Not infrequently parents have
been induced to remove to more healthy dwellings. The interim care committees also suggest the
assessments for the consideration of the Public Health Committee of the Council, and collect the contributions
of parents for the residential treatment of their children. The services rendered by these
committees in the directions indicated have been most valuable in the efficient working of the Council's
tuberculosis scheme.