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groups) is not now so marked as even a decade or so ago; female mortality and
morbidity have declined more slowly. This is a serious matter in so far as the
mother is in closer contact with the family than the father and therefore within
the family is potentially more infectious.
Shorter working hours, higher wages, better canteen and restaurant facilities,
better appreciation of nutritive food values and cleanliness, better clothing, regular
holidays, more transport to the country, improved ventilation at home and at work
and increased popularity of holiday camps, swimming pools, etc., have all made for
better health and lower mortality. The better-off younger families tend to move
out of the Metropolis (though they may continue to work in it), while the poorer
and the disabled have to remain in London to be nearer to their places of work.
Temporary residents and students of the industrial age group (18-45) which carries
the highest tuberculosis incidence, live in the Metropolis in large numbers. The
London population in this respect is not a random sample of the United Kingdom
population, and for the reasons suggested has always shown greater prevalence of
tuberculous infection.
L.C.C. schemes for the treatment of Tuberculosis, 1914, 1922 and 1936
In 1912, the Government Departmental Committee on Tuberculosis already
referred to, recommended that local authorities should be made responsible for
providing facilities to deal with tuberculosis. The Council prepared and submitted
its first scheme in May, 1914. This was approved by the Local Government Board
and included the following provisions:—
Domiciliary treatment of persons insured under the 1911 National Health
Insurance Act to be provided by the panel practitioner. Home treatment of
uninsured persons to be provided by private practitioners, by District Medical
Officers (Poor Law), by voluntary institutions or by the tuberculosis dispensary
physician.
Dispensaries for diagnosis and treatment to be provided by, or arranged
by, each local sanitary authority or by combinations of these, such provisions
to be to the satisfaction of the Council who would contribute a grant for
maintenance.
Hospital accommodation for insured persons to be provided by arrangement
with the Metropolitan Asylums Board, with voluntary institutions or by the
Council itself.
The Council to make arrangements, if and when required and subject to
the approval of the Local Government Board, for residential accommodation
for uninsured tuberculous patients who may be asked to contribute towards the
cost of their treatment.
The Council to make arrangements for accommodation in open-air residential
schools for medical and surgical cases of tuberculosis in children.
In 1922, following on the requirements of the Public Health (Tuberculosis) Act,
1921, the Council revised its 1914 Scheme, mainly in the following respects:—
Dispensary service—Emphasis laid on early diagnosis, services made available
to Ministry of Pensions, appointment of dispensary nurses or visitors;
Each clinic to be linked to a hospital for consultation purposes. Facilities
to be provided by the Council for pneumothorax, dental and sunlight treatment,
X-ray examination and other special diagnostic measures or treatment and for
sending patients to village settlements ;
Tuberculosis Officers to visit patients' homes and examine contacts,
Appointment of Tuberculosis Care Committees.