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37
The returns received from the centres in the London and Home Counties
scheme show a somewhat more favourable result. The peak year in this case was
1920, when 13,096 cases were recorded, while for the year 1936 the number of
cases returned was 11,072.
Treatment of tuberculosis
The Council is under statutory obligation to make, for the administrative
county of London, adequate arrangements for the treatment of tuberculosis at or
in dispensaries, sanatoria or other institutions approved by the Minister of Health,
and also has power to make such arrangements as the Council may think desirable
for the after-care of persons who have suffered from tuberculosis.
The arrangements made by the Council in compliance with the foregoing obligation
and authority are published in detail in document No. 3194 (price 4d.), obtainable
from P. S. King & Son, Limited, 14, Great Smith Street, S.W.1.
It will be sufficient to state, in broad outline, that the scheme resolves itself
into two main divisions, viz., (1) a tuberculosis dispensary service provided by the
Metropolitan Borough Councils in accordance with general principles laid down by
the Council, and (2) arrangements for residential treatment and various auxiliary
services undertaken directly by the London County Council.
As to (1), the tuberculosis dispensary service is under the administrative direction
of the medical officer of health of each borough. The tuberculosis officers work in
co-operation with the medical practitioners of their area, and their services are
available for consultation. They also act as honorary consultants on the staff of
the Council's general hospitals which serves their areas.
The dispensaries are required to be linked with hospitals for special services,
such as provision for X-ray examinations, and artificial pneumothorax refills.
The Council's general hospitals and certain voluntary hospitals are available for
these services.
A tuberculosis care committee (or equivalent organisation) is associated with
each dispensary. The constitution of these committees includes representatives of
the various social service agencies, voluntary and public, operating in the borough
to help families whose social and economic circumstances are disturbed owing to the
presence of the disease in the family.
With regard to (2), residential treatment is provided by the Council both in its
own hospitals or sanatoria and in privately owned institutions.
By this method the Council secures a wide choice of institutions of various types
and is enabled to give attention, in addition to clinical considerations, to personal
preferences of patients, an important factor in some cases, and to such matters as
climatic conditions and social or religious amenities. Patients are, however, sent to
the Council's hospitals and sanatoria if beds equally suitable are available, before
accommodation is taken in voluntary institutions.
The arrangements for residential treatment include the provision of observation
beds (a) for the purpose of diagnosis, and (b) to determine disposal for treatment of
definitely diagnosed cases which present difficulty of decision. These "observation"
beds are provided principally at Brompton hospital, St. George's home, Chelsea,
and in the Council's general hospitals. The last mentioned are also used for acute
and emergency cases and for advanced cases mainly confined to bed.
The voluntary institutions used by the Council include Papworth village settlement
and Preston Hall colony where suitable patients have the prospect of
settlement and employment in the industries, and Burrow Hill sanatorium colony,
which provides for youths between 14 and 18 years of age and, during treatment,
trains them for clerical employment or for gardening work.
A feature of the scheme is the facility with which it is possible to interchange
patients between various types of institution. Thus patients who deteriorate