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still the model, gave the necessary stimulus and direction to public provision for
dealing with the problem. Some of the Metropolitan Borough Councils made
grants to the Central Fund, which by 1913 had instituted 11 dispensaries in London.
The Council's tuberculosis scheme was adopted in May, 1914, and has not
since been varied in its main principles. It was designed, in the first instance, to
supplement existing effort, and, where possible, to incorporate within its activities
all existing organisations.
The scheme provided for the establishment of a dispensary service by each of
the 28 Metropolitan Borough Councils and the Corporation of the City of London
for the population of their particular areas, grants being made to the Metropolitan
Borough Councils by the Council, and for arrangements for residential treatment to
be made by the Council, in the first instance by utilising voluntary institutions,
supplemented by accommodation to be provided by the late Metropolitan Asylums
Board. The late boards of guardians were left to provide under the Poor Law in
the infirmaries for the chronic advanced cases.
Originally, special privileges were accorded to insured persons under the
National Health Insurance Acts, and special arrangements were made for their treatment
by the London Insurance Committee. These privileges were withdrawn by
legislation as from May, 1921, and the Council became responsible for providing
treatment for tuberculosis for all classes of the community, no difference being
made between insured and uninsured persons.
All the Central Fund dispensaries and the two voluntary dispensaries referred
to above were incorporated within the Council's scheme, and in 1913 there was a
total of 19 dispensaries. By 1918 there were 33. The voluntary Central Fund
dispensaries, except one, were transferred to the Metropolitan Borough Councils in
1921, and at the present time there are 35 dispensaries, including 3 branch dispensaries,
of which 9 are at voluntary hospitals. From 1915 onwards there has
been in association with each tuberculosis dispensary a tuberculosis care committee
or other similar organisation, whose function is to look after the social welfare of
the patients. The passing of the Local Government Act, 1929, which constituted
the Council as the hospital authority for London, changed materially the status
and functions of the Council as the bed-providing authority under the tuberculosis
scheme. The Council still, however, continues to use voluntary institutions, both
to supplement its own provision and to provide for various special kinds of cases,
such as those who need treatment under special environmental conditions or in a particular
social or religious atmosphere. Among the voluntary institutions used for the
Council's patients may be mentioned Papworth and Preston Hall colonies. Patients,
if suitable, are accepted by the authorities as settlers in the residential villages associated
with these colonies. At Burrow Hill colony boys from the age of 14 to 19 are
given treatment combined with training in gardening or clerical work. A number of
the boys trained in gardening are absorbed each year in the Council's parks
department.
In the first instance it was the practice to assess patients to pay contributions
towards the cost of treatment, having regard to their financial position; but, since
July, 1934, treatment has been provided free of charge, although voluntary contributions
are accepted from patients who are in a position to make payment and wish to do so.
The growth of the arrangements for residential treatment may be seen from
the table set out on page 42.
The large increase shown in the figures for the years from 1931 onwards is due
to the transfer of functions from the poor-law authorities to the Council. Since 1933,
admissions to beds in the tuberculosis wards of the Council's general hospitals have
been made through the tuberculosis scheme.
The Council has developed its preventive work in two additional directions
(a) the provision of open-air schools and (b) the arrangements for boarding-out of
child contacts. As regards the first of these, a voluntary school was established in
1909 at Kensal House, Paddington, under the auspices of the Central Fund for the
Prevention of Tuberculosis. This was transferred to the Council in 1917. The