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96
TUBERCULOSIS.
Prior to compulsory notification of tuberculosis the only
official information with regard to the disease was contained in
the death returns of the Registrar. The notification of pulmonary
tuberculosis, at first voluntary, was afterwards made compulsory
by Poor Law Medical Officers in 1909 but tuberculosis was expressly
excepted from the compulsory powers relating to infectious disease
generally and no restrictions could be placed upon any tuberculous
person regarding himself, his employment or his residence.
Apart from disinfection, which could not be enforced, nearly
all steps to combat tuberculosis were taken by voluntary associations.
The tuberculosis dispensary system in London was initiated
by a voluntary association called "The Central Fund for the Promotion
of the Dispensary System for the Prevention of Consumption
in London," the medical adviser to this Central Fund being Sir
Robert Philip, the first Professor of Tuberculosis of the University
of Edinburgh. The Edinburgh system for the prevention of tuberculosis,
with the dispensary as the centre of the activities, comprised
sanatorium, hospital for advanced cases, farm colony,
open-air school, handicrafts class and care committee work in the
home. The Central Fund opened the first dispensary in London
in Paddington in 1909, and by 1913 Central Fund dispensaries
were working in nine boroughs.
Two sets of Regulations in 1911—the Public Health (Tuberculosis
in Hospital) Regulations and the Public Health (Tuberculosis)
Regulations—brought into being the system of compulsory
notification of all cases of tuberculosis and arising out of these
Regulations the Public Health Committee resolved to supply
sputum flasks to tuberculous patients needing them. Hospital
accommodation at that time was 120 beds at Hackney Union
Infirmary.
The first open-air school in London was the Kensal House
Open-Air School in Paddington which accommodated 100 children
and was transferred in 1917 to the London County Council, the
Tuberculosis Officer of the dispensary remaining in medical charge
with the help of a tuberculosis nurse attached to the dispensary.
After working in several Central Fund tuberculosis dispensaries
I became Tuberculosis Officer at the municipal tuberculosis dispensary
which was established in 1913 at Greenwich. At that
time the municipalities were taking over the Central Fund dispensaries
or establishing dispensaries of their own. Attempts in
Hackney by the Borough Council to establish schools for tuberculous
children, and also nursery schools, were not successful, with the
exception of Stormont, House for tuberculous children which was
controlled by the London County Council and visited by Dr. Howell,