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The total number of beds for insured and uninsured available and in use at the end of December,
1919, say, 1800.
From these figures it would appear that there is a nett addition required of approximately 1,000
beds. It is believed that (a) the provision of from 250 to 300 beds for advanced cases of the disease
should be regarded as one of the most immediate requirements, and that the acquisition by the Metropolitan
Asylums Board of the hospital at Hendon, within the last few weeks, will go a long way towards
meeting these requirements;
(b) The provision of 200 beds for observation and emergency cases can be made to a substantial
extent in existing institutions when the present accommodation has been carefully re.graded. Thereafter
probably about 100 additional beds will be required in the several London hospitals which it is
proposed shall be used as " Mother Hospitals " to groups of adjacent dispensaries;
(c) Special arrangements of an entirely new character will have to be made to meet the needs
of cases of " surgical tuberculosis " in adults. There is a serious dearth of accommodation available
for these cases. It is therefore suggested that in considering the provision of new, and the acquisition
of existing suitable, buildings for the treatment of the tuberculous, the attention of the Metropolitan
Asylums Board should be specially drawn to this very important fact. About 200 new beds are required
for cases of this character ;
(d) In connection with the institutional treatment of moderately advanced cases of tuberculosis
it is doubtful whether any new accommodation will be required in the immediate future for cases of
this type. At all events it would be wise for the present to await the results obtained from (1) the re.
grading of existing accommodation; (2) the more careful selection of cases for sanatorium and other
institutional treatment; and (3) the possible development of after.care schemes, before deciding to
make any definite addition to the existing institutional provision for such cases ;
(e) The small number of emergency beds required will probably be easily provided for in the
several London hospitals;
(/) A substantial amount of institutional treatment for tuberculous children is being made at the
present time by the Invalid Children's Aid Association as a portion of an agreement with the Council.
There is no reason why this arrangement should not continue; but if the agreement for any reason
comes to an end, it would become necessary for the Council to provide for an addition of some 200 beds
to its present total, bringing the aggregate figure to considerably over 800 beds. On the other hand,
the growth in the provision of open.air schools may sensibly diminish in time the need for further
institutional accommodation. The additional accommodation required for 1920.21 may be estimated
at 50 beds.

Estimated number of beds required for adults (insured and uninsured) and
children, 1920.21 2,750
Estimated number now in use—December, 1919 1,800
Deficit 950
With reference to the estimated deficiency of 950 beds, it is to be noted that from 250 to 300
have quite recently become available, reducing the net estimated deficiency to, say, 700 beds. There
are good grounds for the belief that about 200 more beds can be secured without any serious difficulty
in existing institutions, leaving about 500 more beds therefore to be provided by means of new, or the
acquisition of suitable existing, buildings. At least 200 of these 500 beds should be specially reserved
for cases of surgical tuberculosis in adults, and possibly the remainder may be required for advanced
cases. It is expected that any additional beds which may be wanted for children will be available in
the two institutions, Highwood and Margate, recently opened by the Metropolitan Asylums Board ; but
it should be pointed out that serious difficulties have occurred from time to time in making provision
for tuberculous children in our schools for the mentally defective and those who are inmates of residential
industrial schools. Some special arrangements will have to be made in the near future for these
two classes of children, as they are not, for obvious reasons, welcomed at the ordinary institutions.
The total numbers of such cases is, however, fortunately very small, probably not more than about
six to ten cases annually.