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Board and 231 in voluntary institutions for children, until the termination of the war
This involved selection of the most favourable cases, but the Metropolitan Asylums
Board were able to adapt St. George's Home, Chelsea, for advanced cases (women)
and to receive a proportion of such cases (women) at the Northern Hospital, Winchmore
Hill, and Downs Sanatorium (men), the latter being largely insured persons.
The problem of the advanced case has presented considerable difficulty, both
from the preventative and treatment points of view. Before the advent of county
councils and borough councils practically the only institutions available were the
poor law infirmaries.
The fact that 50 per cent. of the Council's expenditure on the treatment of
tuberculosis is met by Exchequer grant, which is not available in relief of poor law
expenditure, has resulted in continual pressure upon the Council to provide accommodation
for these cases. It has been emphasised throughout that the institutions
should be near enough to the homes of the patients to enable relatives to visit and
even to permit of patients from time to time being allowed to visit their homes.
Infirmaries are generally local and some of them have quite suitable accommodation.
It has always been felt that the extensive provision of new accommodation would
involve waste of this accommodation and that a large class of chronic cases more or
less destitute and likely to live for indefinite periods should be accommodated in
these institutions. Some advocates have urged the provision of small " homes "
of 20 to 30 beds where certain unavoidable features of large institutions which
become irksome can be relaxed. Investigation has indicated that such institutions,
apart from other unfavourable considerations, are comparatively very costly and
it has been necessary to meet the demands by the provision of large institutions.
This has been done by the Metropolitan Asylums Board, who, in addition to St.
George's Home and Winchmore Hill Hospital, placed Colindale Hospital, Hendon,
containing about 325 beds, at the disposal of the Council and has now adapted Grove
Park Hospital, Lee, for the accommodation of 320 patients. There is, however, a
number of small institutions both in London and in various parts of the country
to which specially selected cases are sent.
The duty of deciding suitability for residential treatment has always rested
upon the medical officer of health of the Council, but throughout he has had the
advantage of various aids, other than the original medical reports, in arriving at
his decisions. It was recognised that varying standards would operate amongst
medical men, and the Council was able to obtain the co-operation of leading
consultants who were formed into an advisory board. This board drew up a
medical classification describing the types of case which may roughly be divided
into "early," " moderately advanced " and " advanced," and this classification, with
slight modification, has been used by the Ministry of Health in their circular 37t
dated September, 1925, to local authorities, laying down regulations as to uniform
records and statistical returns throughout the country. Notwithstanding this
guidance it was felt that personal examination of a number of cases would be
necessary, and the Council arranged a rota of consultants to examine patients at the
County Hall and the disposal of the patients was determined on their reports.
This arrangement in practice was found to be unsatisfactory, and a later
development was the setting aside of a definite number of beds in hospitals in
London, principally Brompton Hospital, and the City of London Chest Hospital.
Victoria Park, for the " observation " for short periods of cases which the medical
officer of health of the Council was unable to accept for residential treatment on the
information given in the medical reports.
Experience showed the advisability of a middle course. The requirement that
all cases which could not be determined on clinical reports should be admitted to
hospital led to congestion and delay in treatment, and provision was made for the
examination of a proportion of doubtful cases at County Hall by a clinical medical
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