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45
survival and condition at the end of the year 1933. No selection was made, the
investigation including all cases which could be traced in 1933. This number was
677 cases, comprising 418 females and 259 males. The value of artificial pneumothorax
was assessed by comparing the fate of the 677 cases with that of 3,329 cases
treated by conservative methods only, after correction for age, sex and clinical
classification, before this form of treatment came into general use. Both groups
were classified and followed up in a uniform manner and were drawn from identical
sociological and environmental sections of the population. All the 677 pneumothorax
cases were followed up for a minimum period of 3 years while 411 of them
were observed over a period of five years. The 3,329 "conservative" group were
followed up for five years.
The report, which is of an exhaustive nature, has been published by the Medical
Research Council and may be obtained from His Majesty's Stationery Office. It
will be sufficient here to quote the following paragraph (page 88, no. 9) of Dr.
Bentley's conclusions from his investigation:—
The results of pneumothorax therapy as judged by the results in the 677 new cases here
investigated show a gain in lives of 129.53 at the end of 3 years, that is an increase in the number
alive over the expected number amongst those conservatively treated of 19.1 per cent. The
smaller group followed for 5 years shows a gain in the number alive of 18 per cent. at the end
of 3 years and 19.8 per cent. at the end of 5 years.
The tuberculosis dispensary service in London, while forming an integral part
of the Council's tuberculosis scheme, is provided by the Metropolitan Borough
Councils under conditions laid down by the Council.
Tuberculosis
dispensary
service.
An annual grant, based on actual expenditure approved by the Council for the
year, was formerly made by the Council to the Metropolitan Borough Councils, subject
to the dispensary service being carried out to the satisfaction of the Council. The grant,
as nearly as possible, represented 25 per cent. of the actual net approved expenditure
after deduction of the sum paid by the exchequer to the Metropolitan Borough Councils
in compensation for loss of income arising from the withdrawal of "sanatorium
benefit" for persons insured under the National Health Insurance Acts. The question
of these grants was reviewed during 1933, and the Council, as from 1st April, 1933,
substituted, for annual percentage grants based on actual expenditure, a system of
fixed block grants in the form of annual payments of fixed amounts operating for
periods of three years, based on examination of audited statements of actual expenditure
during the triennium immediately preceding the commencement of each block
grant period, together with a further statement of the amount of the probable
expenditure by the Metropolitan Borough Councils during the ensuing grant period,
and reasons for variations from previous expenditure. This arrangement does not
include the City of London, which maintains its own dispensary at St. Bartholomew's
hospital.
There are now 33 dispensaries in all, including 4 branch dispensaries. Of these,
25 are ad hoc municipal dispensaries, and 8 (including 1 branch dispensary) are at
voluntary hospitals or under voluntary management. This excludes the City of
London dispensary at St. Bartholomew's hospital. In some cases a borough has
two dispensaries, while in other cases a hospital dispensary serves more than one
borough.
In order to encourage the closer association of the municipal dispensaries with
the Council's general hospitals, special facilities have been made available enabling
the Borough Councils' tuberculosis officers to utilise the hospital X-ray installation
for their patients and also to provide their patients with artificial pneumothorax
refills at the hospitals. This has resulted in an increased number of boroughs
arranging for the whole or part of their work in this connection being carried out
at the Council's general hospitals.
Detailed information has been furnished by the Metropolitan Borough Councils
tuberculosis dispensary service as to the work of the tuberculosis dispensaries,
including particulars as to the numbers of new cases and "contacts" examined,
and the number of home visits, etc. The information is summarised in the table
on pages 46 and 47.