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61
considerable extent the practice has been adopted of seeing patients by appointment.
A system has been inaugurated by which information is interchanged between
the tuberculosis officers and the school doctors as regards the progress of school
children whose names are on the dispensary register. Special provision has been
made in the dispensaries for the tuberculosis officers to be relieved of clerical
work.
Tuberculosis
care
committees.
Another important development has taken place in the establishment of
tuberculosis care committees in nearly all the boroughs. 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. 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.
The number of interim tuberculosis care committees appointed by the Council
was 30.
In 1922 the Ministry of Health addressed a circular to metropolitan borough
councils expressing the opinion that the time was opportune for the establishment
of permanent committees. As a result schemes were submitted by most of the
borough councils. At the present time all the borough councils with four exceptions
have permanent committees working under schemes approved by the Council and the
Ministry of Health. In two boroughs (Islington and Bethnal Green) the interim
committees continue to function. In Lambeth the care work is discharged by an
officer of the borough council of the almoner type for the municipal ad hoc dispensary,
and by the lady almoner's department of St. Thomas's Hospital in connection with
the branch dispensary established at that hospital; and in Bermondsey the arrangements
for carrying on the work still remain in abeyance. In 13 boroughs the
secretarial work is discharged by paid secretaries, and in 10 boroughs by hon.
secretaries. In the borough of Paddington the medical officer of health acts as
secretary. The care committees include among their members representatives of
all agencies, public and charitable, operating in their areas and this facilitates
co-operation in social work and avoidance of duplication of visiting and of
effort.
In many cases the occurrence of tuberculosis in a family seriously disturbs the
economic balance, and it is the primary aim of a care committee to give such advice
and assistance as circumstances dictate to enable the family to tide over the most
difficult period, to maintain or, if lost, to regain, economic independence and to
enable the patient to derive the fullest possible advantage from the medical treatment
prescribed. The widely varying circumstances of the homes from which
tuberculous patients come, make it impossible to give an exhaustive account of
the problems with which the committees have to deal. The following are some of
the matters which frequently engage the attention of the committees:—
(а) The provision of extra nourishment for the family.
(b) The provision of extra room or extra bed accommodation.
(c) The provision of an open-air shelter for erection in the patient's garden.
(d) The removal of the patient to friends or relatives in the country, or
the relief of the family by the boarding out of the children and the finding
of suitable work for the patient or other members of the family.
(e) The care of the children and of the home during the absence of the
mother and housewife.
(f) While avoiding anything in the nature of a sanitary inspection, which is
carried out by officers of the borough council, the care committee bring to the
notice of the public health authority any obvious defects, sanitary or otherwise,
requiring investigation.
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