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(v.) It shall be referred to the medical officer of the dispensary to forward to the medical
officer of health for the borough in which the patient resides a report on each case in a
prescribed form, which shall include his classification of the case upon clinical grounds
indicating by an appropriate classification the relative degree of suitability of the case.
(vi.) It shall be referred to the local medical officer of health to classify the cases as to
home conditions in three classes—(a) satisfactory, (6) doubtful or unsatisfactory, (c) removal
urgently necessary.
(vii.) In cases recommended for in.patient hospital treatment or sanatorium treatment,
the papers shall be forwarded to the county medical officer.
(viii.) The county medical officer shall refer to the rota all cases in which, in order to
ensure uniformity of administration throughout London or for other reasons, the advice of the
referees is required by the Council.
(ix.) The judgment of the medical referees shall not be subject to clinical review by the
Council.
(x.) Institutions accepting payment from the Council for in.patient treatment shall,
subject to the foregoing provisions, be required to admit patients of the class they have agreed
to take, whether for sanatorium or in.patient hospital treatment, when sent thereto by the
Council, but institutions will be expected to make representations to the Council if, after the
admission of a patient, it is found that such patient is not benefiting from the treatment received.
Except in a case of insubordination, no patient shall be required by the authorities of an institution
to leave until after due notice has been given to the county medical officer of health,
and arrangements have been made for dealing with such patient on his discharge. Subject
to the foregoing, the institution shall not be obliged to retain a patient if the physician in charge
certifies that further treatment in the institution is unnecessary.
IV.—Treatment of children.
Non.residential treatment.
13. Children suffering from tuberculosis who, in the opinion of The school medical officer, can be adequately
treated in a non.residential institution and whose home conditions are such as not prejudicially
to interfere with curative treatment, shall be dealt with in non.residential open.air schools, in schools
certified under the Elementary Education (Defective and Epileptic Children) Act, 1899, or such other
special schools as the Council may decide, having regard to the circumstances of each case.
Residential treatment.
14. Arrangements shall be made by the Council, subject to the approval of the Local Government
Board, for the provision of accommodation in open.air residential schools or other suitable institutions
for medical and surgical cases of tuberculous children requiring treatment in residential institutions.
The amount of accommodation to be provided will be determined from time to time by the Council.
The Council, in making such provision, shall take advantage of accommodation already provided
by hospital, sanatorium or other authorities, including the Metropolitan Asylums Board, or of such
additional accommodation as such authorities are prepared to provide. The Council, being of opinion
that adequate accommodation will thus be available, does not consider it necessary itself to purchase,
erect or maintain institutions.
15. No institution for the reception of children capable of receiving instruction, shall be considered
suitable for the accommodation of children for whom the Council is providing treatment which
is not certified under the Elementary Education (Defective and Epileptic Children) Act, 1899, or otherwise
approved by the Board of Education.
V.—After.care.
Adults.
17. Upon discharge of an adult patient from a hospital or sanatorium due notice shall be given
by the medical officer of health of the county to the medical officer of health of the borough in which
such patient resides with a view to securing, through the staff of the dispensary or otherwise, the aftercare
of such person. Notice should also be given by the local medical officer of health to the institution
or practitioner under whose care the patient was before he received residential treatment.
Children.
18. The arrangements specified in clause 17 shall apply in the case of children who, in addition,
may be referred upon their discharge from residential institutions and also while attending open.air
day schools to the appropriate Children's Care Committee. Full records shall be kept by the school
medical officer.
VI.—Finance.
(1) Insured persons.
19. The cost of the appropriate treatment of insured persons suffering from tuberculosis should
be borne by insurance funds. No part of such expenditure shall be defrayed out of the County rate.
55580 u