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(iii.) The day sanatoria classes were established in 1917 in connection with the voluntary tuberculosis
dispensaries in the following boroughs—Battersea, Fulham, Bermondsey, Camberwell and
Hammersmith. The children are selected by the dispensary doctor, and admitted to the classes on the
authority of the Public Health Department of the Council. The classes are inspected by the Council's
officers. The Council provides teachers and some equipment. The difference between the children
in attendance at these sanatoria classes and those in attendance at the open-air schools is that the former
are known definitely to be suffering from active tuberculosis, while in the case of the latter the children
are of a pre-tuberculous type.
The day sanatorium class in Ravenscourt Park, Hammersmith, was organised by the Invalid
Children's Aid Association.
(iv.) In 1910, a school for tuberculous children was opened at Kensal House, in premises provided
and maintained by the Paddington dispensary for the prevention of consumption, the education being
provided by the Council. The children come from homes where proper treatment can be relied upon,
whereas the children who attend day sanatoria classes are living in less favourable homes, and are in need
of more medical inspection than the Kensal House children. The Board of Education agreed to recognise
the Kensal House school under the terms of the Elementary Education (Defective and Epileptic Children)
Act, 1899, provided that the school was confined to such children having incipient phthisis, or with the
disease in a definite form, or sub-acute or chronic in nature, as are unable on account of physical unfitness
or debity to benefit by instruction in an ordinary public elementary school, but are not incapable, by
reason of their physical condition, of receiving benefit in a special school.
(v.) The day schools for physically defective children are certified by the Board of Education
under the Act of 1899. Thirty-six such schools have been provided, situated fairly evenly over London.
Arrangements are made for the conveyance of the pupils to these schools by means of ambulances and
hired omnibuses, except in the case of those who are passed by the school doctor as suitable for walking
to school, or for riding by public conveyance. The children are provided with a mid-day meal, which
is prepared on the premises, and the parents contribute towards (except in necessitous cases) the cost
thereof. The schools are under constant medical supervision, and a trained nurse is in attendance.
(vi.) A few open-air classes are carried on by voluntary agencies such as Miss MacMillan's Camp
School at Deptford and the Regent's Park Bandstand Class.
Provision for education is also made by the Council in schools at Cromwell House, Highgate, N.,
the National Orthopaedic Hospita1, Great Portland-Street, W., the Alexandra Hospital, Bloomsbury,
and the Hospital and Home for Incurable Children, Hampstead.
II.
Number of children—In connection with an inquiry made four years ago as to the needs of school
accommodation for tuberculous children it was ascertained that there were, in the County of London,
about 1,00 0 children who had been excluded from ordinary elementary schools on account of tuberculosis.
We are advised, however, that the number of tuberculous children now to be provided for is much in
excess of this number, and it is considered that the number of school places required for pulmonary cases
may be estimated at 2,000. We are also advised that, in addition to these 2,000 children definitely notified
as tuberculous, there are 2,000 requiring open-air treatment owing to anaemia, debility, or incipient
tuberculosis, and that, so far as can be seen, and looking ahead for about ten years, these figures can be
regarded as complete.
III.
Proposed types of schools—In actual practice the only difference between the tuberculous children
in attendance at the day sanatoria classes and the Kensal House school, from the medical point of view,
is that they are suffering from tuberculosis in a greater or less degree, and, therefore, capable of education
in inverse proportion to the activity of the disease. This means that a child at a day sanatorium class
is capable of receiving a less amount of education that a child at Kensal House. If the fact of notification
is taken as the reason for the admission of a child to the school, then the only consideration is whether
the child is in need of treatment, and, if so, can the treatment be satisfactorily given in a day sanatorium
or not 'i The amount of education, in such institutions will naturally be subject to the condition of the
child, and will vary considerably from week to week.
We, therefore, suggest that the Council should consider the desirability of recognising and
establishing one type of day school for the definitely tuberculous children of school age, and that the only
children to be admitted should be those who are notified cases of tuberculosis. We also consider that
the school should approximate to Kensal House school. It would also be desirable to aim at an average
attendance of, say, 100 children, inasmuch as a unit of this size would enable the school to be economically
managed and would also provide for proper classification of the children in respect of their tuberculous
condition and their educational attainments. It may, however, be found more convenient, having
regard to the needs of particular districts or to the possibilities in certain districts of obtaining accommodation
at a lower cost, to vary this figure slightly. The type of child with incipient phthisis or who
is anaemic or debilitated, but with no definite evidence at the time of examination of active tuberculous
disease, is either in attendance at an elementary school, or " out of school," and should, we consider,
be provided for by means of a special school of the open-air type on the fines of the Birley House School.
If these proposals are accepted, the practical effect would be that a tuberculous child, having
been excluded from an elementary school, and notified to the medical officer of health as such, would be
sent either to a school for tuberculous children or to a sanatorium for residential treatment under the