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The National Health Insurance Act, 1920, withdrew sanatorium benefits from
N.H.I, patients and the Council's scheme from then applied equally to the insured
and uninsured.
The Local Government Act, 1929, transferred to the Council the hospital
functions and properties of the Metropolitan Asylums Board and metropolitan
boards of guardians. The Council thus, in April, 1930, became the owners of the
World's largest group of hospitals under local authority management and found itself
possessed of 1,700 beds in sanatoria and surgical tuberculosis hospitals, apart from
beds for chronic tuberculous cases in general hospitals, in asylums and mental
deficiency colonies, as well as special groups of hospital beds for children ; there were
provided subsequently units for tuberculous maternity cases and a pleural effusion
unit; while day and residential open-air schools, were part of the Council's education
service.
In his Annual Report for 1932, the County Medical Officer proudly
announced that "the development of the Council's tuberculosis scheme over a period
of approximately twenty years has been gradual and may now be regarded as
comprehensive."
By a revised consolidating scheme—dated 1936—following on the County of
London (Tuberculosis) Regulations, 1930, the Council also provided additional
facilities for the maintenance of children exposed to tuberculosis when one or both
parents were undergoing hospital treatment for tuberculosis and therefore unable to
look after the child. This provided an extension of the existing boarding-out scheme
for child contacts.
The 1936 treatment of Tuberculosis scheme continued the existing arrangements
with borough councils for dispensaries and voluntary care committees and made all
treatment and services for the tuberculous free of charge.
The Council continued to make use of voluntary colonies and village settlements
for the industrial rehabilitation of suitable patients.
The effects of two major wars
The half century under review includes ten years of devastating war. The first,
from 1914 to 1918, was accompanied by an increase in mortality from tuberculosis,
mainly due to severe food rationing, and was followed by a wave of widespread and
prolonged unemployment.
In 1918, the last year of the first World War, 160,545 London men who were
examined for military service included 5,238 rejected or deferred on account of
tuberculosis (911 of them non-pulmonary) an incidence of 3.2 per cent.
These figures, however, do not refer to a random sample of the population and
only to the last year of war when it might be presumed that the healthier male
residents had mostly already been recruited into the Forces. Nevertheless it denotes
an appalling prevalence.
The second World War, from 1939 to 1945, was more severe than its predecessor
in its involvement of the civil population in physical danger from bombing, severe
anxieties, food rationing, "black-out," the considerable employment of women in
industry, serious crowding in homes, workplaces and shelters, and evacuation into
country districts of many women and children.
This war, soon after its onset, showed a sudden and sharp rise in tuberculosis
incidence and mortality. Recognised health hazards from bad ventilation in
darkened, crowded factories led, in 1943, to the use by the Council of mobile miniature
mass X-ray units to examine volunteers in factories, in the hope of discovering and
removing infective, previously unknown cases of tuberculosis. Many cases of active
and of very early tuberculosis were brought to light in this way, and the use of such
mobile mass X-ray units was continued and extended when the war ended.