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156
Tuberculcsis
CHAPTER III.
PUBLIC HEALTH.
The responsibility in London for the public provision of treatment for tuberculosis
rests on the Council, which in 1914 prepared a comprehensive scheme, revised
in October, 1922.* Under this scheme the Council arranges for the provision of
residential treatment required through a public authority (other than poor law
guardians). The metropolitan borough councils provide or arrange for the provision of
dispensary treatment. Various particulars of the work done under the scheme are
given in Chapter I. of this volume (pp. 14-20 and 32-38).
During theyear consideration was given to the position of the Council in relation
to the tuberculosis dispensary arrangements made by the metropolitan borough
councils, in accordance with the terms of the Council's tuberculosis scheme, having
regard to the new basis of Government grants provided for under the Local
Government Act, 1929. Under the financial provisions of the scheme, each borough
council receives at the present time, in respect of its tuberculosis dispensary arrangements,
the following grants:—
From the Exchequer:—(1) Block grant of fixed amount in consequence of the
termination of sanatorium benefit. (2) 50 per cent, of remainder of approved net
expenditure.
From the Council: —Half the balance of net expenditure approved by the
Council after deducting Exchequer grants. On the basis of the continuance of the
present arrangements, it was deemed that the case would be met by a variation of
the scheme so as to provide for the payment by the Council to the borough councils,
after 31st March, 1930, of 25 per cent, of the balance of net expenditure approved
by it, after deducting an amount equivalent to the fixed Exchequer block grant
previously paid in consequence of the termination of sanatorium benefit. This is,
in effect, to retain the present financial relationship between the Council and the
borough councils, and is regarded as a temporary measure pending further review.
One of the chief problems connected with the after-care of tuberculous persons
is that of suitable employment on discharge from sanatorium treatment. This
question has been under constant consideration, and a comprehensive report on the
subject was prepared by the county medical officer in 1928.** The Council has always
been anxious to encourage promising schemes of employment, but in its view the
question is one of national rather than local policy. Various schemes have been
investigated and the Council decided to employ a number of tuberculous ex-service
men in its parks and open spaces. An experimental scheme for the employment of
not more than nine women patients on nursing and domestic duties has been in
operation for a year at the King George V, Sanatorium and is now under review.
Surveys are made at five-yearly intervals of the condition of persons discharged
from residential treatment. Surveys have been completed in respect of adults and
children discharged in 1921, 1922 and 1923.
Developments of the tuberculosis dispensary service are made from time to
time with the approval of the Council and the Minister of Health.
In the light of experience gained the Council decided to terminate, on 31st
March, 1929, the experimental arrangements then in operation for the treatment in
suitable cases by artificial light, and treatment is now only approved by the Council
in exceptional cases. Experience so far indicates that the best results are obtained
only when this form of treatment is given in conjunction with residential treatment
at institutions in the country.
* Scheme for the treatment of tuberculosis in London. No. 2183. Price 4d.
** Employment uf tuberculous patients. No. 2545. Price Is.