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Estimated requirements.
(a) Insured persons.—The medical adviser of the London Insurance Committee states that to
apply the " Astor " standard to the 1,500,000 insured persons would only yield 600 beds, which is quite
inadequate, though it should be pointed out that the demand for beds has been complicated by two
factors—(1) the large number of soldiers and sailors discharged as tuberculous from the Services and for
whom institutional accommodation had to be made by the London Insurance Committee ; and (2) the
unsatisfactory methods which have prevailed for the selection of suitable cases for the various forms of
institutional treatment. With those reservations in mind the records of the London Insurance Committee
for the period July 1st,1918 to June 30th, 1919, serve to illustrate the demand for institutional treatment.
Number of cases recommended to the committee for institutional treatment, 1.7.18.30.6.19 :—
Males (including ex.Service men) 4,090
Females 1,183
5,273
This total is exclusive of 240 ex.Service men admitted direct from military hospitals to beds for very
advanced cases.
After eliminating those cases not entitled to sanatorium benefit and those who did not persevere
with their applications, the total actual number of cases admitted to institutions amounted to 4,000,
classified as follows :—
Early cases 1,200—30 per cent.
Acute and moderately advanced cases 2,000—50 „ „
Very advanced cases 600—15 „ „
Surgical 200— 5 „ „
The number of cases under institutional treatment on 1st July, 1919, was as follows :—
Males (a) ex.Service men 628
„ (6) civilians 177
Females 266
1,071
On the waiting list:—
Males (a) ex.Service men 54
„ (6) civilians 120
Females 86
360
iSeasonal variation.—In this connection it is important to note that the demand for institutional
treatment is not constant. Usually it rises with the advent of spring and falls off again in the autumn
(though in 1919, owing probably to the unusual mildness of the weather, this falling off was much less
marked), the period of greatest demand being from April to October. During the winter months the
average bed occupation was about 850, whereas in the height of the summer is was found that fully
1,300 beds were needed.
Distribution of beds.—Of the 1,071 beds, about 700 were obtained in institutions in or close to
London, the remaining 371 being secured in 37 different institutions scattered throughout England and
Wales.
Future requirements for insured persons.—The large number of ex.Service men referred to the
Insurance Committe for treatment during the years 1918 and 1919 may be regarded as an exceptional
factor which will tend to become of less importance. On the other hand it is probable that the incidence
of tuberculosis among the general population has increased since 1914 (Appendix IX.). Also
it must be borne in mind that, owing to the inadequacy of institutional accommodation during the last
few years, the demand for such treatment has been discouraged. Increased facilities may, therefore, be
expected to be followed by increased applications. Should the additional accommodation that may
be arranged for prove more acceptable that some now provided ; and, further, should it be found possible
to give assistance in some manner not hitherto attempted to the dependants of patients while in institutions,
the demand for institutional treatment may be expected to increase substantially.
Estimate of requirements for insured persons in the immediale future (Dr. Bardswdl).
For the treatment of— Beds.
(а) 1,200 early cases—on the basis of an average of six months'
residence 600
(б) 2,000 moderately advanced and acute cases, on the basis of an
average of three months' residence 500
(c) 600 advanced cases on the basis of an average of four months .. 200
(d) 200 surgical cases (12 months' residence) 200
1,500
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