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an appendix to this report dealing with a survey of the work carried out during the five years of the
operation of the scheme. Shortly, it provides that:—
1. The Council shall provide the necessary accommodation in residential institutions,
except as regards advanced cases, for uninsured persons, utilising institutions of the Metropolitan
Asylums Board and voluntary institutions for the purpose,
2. The London Insurance Committee shall be responsible for dealing with "Insured"
persons.
3. The provision of dispensaries (subject to the financial arrangements referred to above)
and the supervision of patients in the homes shall be the function of the borough councils,
who may enter into agreement with the London Insurance Committee for dealing with insured
persons at the expense of the London Insurance Committee.
In September, 1915, the reservation with regard to advanced cases was modified to the extent
of accepting beds for women in St. George's Home, Milman Street, Chelsea, an institution belonging to
the Metropolitan Asylums Board, and during the present year an institution for men known as Colindale
Hospital, Hendon, has been acquired by the Metropolitan Asylums Board for men whose removal from
home is necessary on public health grounds, whether insured or uninsured. The problem of making
still further provision for advanced cases is under the consideration of the Council.
Parents are charged roughly what it costs to keep children at home, and adult patients or the
persons responsible for maintenance of adult patients are required to make small payments if the income
exceeds £160 a year and the circumstances justify a charge being made.
In June, 1915, the Council adopted a model scheme for the appointment by borough councils of
Tuberculosis Care Committees, the membership of which is to be representative of all the agencies in the
borough, official and voluntary, engaged in dealing with patients suffering from tuberculosis. These
include the following:—
Body represented. Medical. Associated workers.
Tuberculosis dispensary Tuberculosis officer. Several members.
Borough council Medical officer of health. Lady sanitary inspector.
London County Council Divisional medical officer. Organiser engaged on care work.
Insurance Committee
Board of Guardians
The Committee should also include the almoner or other representative of the local hospitals, the
local secretary and additional members of the Invalid Children's Aid Association, a member of the
district nursing association and local social workers and members of other bodies dealing with tuberculous
persons.
The duties of these committees are: —Investigation of home and social circumstances of patients
when required ; paying special attention to avoidance of unnecessary duplication of Visits and of dealing
with matters which come properly within the purview of the Medical Officer of Health or the sanitary
inspector of the borough; the provision of extra assistance, such as additional food, change of air,
clothing, better home conditions, more suitable occupations, etc., which may be needed to enable
patients to benefit to the fullest extent from the treatment provided.
The Committees, in addition to social work involved in the care of tuberculous patients, undertake
work in connection with assessment and collection of contributions.
As the borough councils were unable in 1915 to appoint these committees owing to war conditions
the Council organised and appointed interim committees until such time as the borough councils were
able to take over the work.
Further extension of the tuberculosis scheme was made in April, 1916, when the Council completed
an agreement with the Invalid Children's Aid Association for the treatment of tuberculous children in
convalescent homes, and for the provision of surgical instruments and other accessories to the treatment
of the children. For this purpose the Council from time to time makes grants in aid from the contributions
received from parents whose children have received institutional treatment.
Experience having indicated the need for facilities for dental treatment, the Council in June,
1919, approved an extension of the tuberculosis scheme so as to provide for dental treatment for uninsured
adult and child patients, as part of the dispensary schemes of the borough councils.
The scheme in regard to children was extended in 1919 by the decision of the Council to provide
throughout London open-air schools for children who had been notified as suffering from pulmonary
tuberculosis or tuberculous glands without discharging sinuses.
With regard to the Care Committee work, the number of Interim Tuberculosis Care Committees
appointed by the Council was 30. During 1919 Chelsea, Hackney and Stoke Newington (combined),
Hammersmith and Southwark Interim Tuberculosis Care Committees were replaced by borough committees
; the boroughs of Hackney and Stoke Newington continuing to have a combined committee.
In addition, the two Interim Tuberculosis Care Committees for Wandsworth were replaced by one
borough committee, thus making five borough committees serving six boroughs. At the end of 1919
there were 25 Interim Tuberculosis Care Committees continuing to render assistance under the scheme.
The reports received in the Public Health Department of the Council during 1919 concerning the
home conditions and after-care of patients who have received institutional treatment through the Council,
indicated that a considerable amount of success has attended the zealous and exacting work carried out
by these committees.
The year 1919 is the first year during which dispensary schemes were in operation in all metropolitan
boroughst or a complete year. There are 33 dispensaries, of which 11 are provided by the central Fund,
2 by other voluntary committees, 11 at hospitals, and the remaining 9 are municipal dispensaries.