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Ill
the latter, by enacting that all cases of tuberculosis should be at once notified to the district
Mcdical Officer of Health.
In 1911 "sanatorium benefit" was included as one of the provisions of the National
Health Insurance, but it was realized that any scheme dealing with tuberculosis should be made
available for the whole community, and not mereiy for insured persons; so in the Public Health
(Prevention and Treatment of Disease) Act, 1913, effect was given to recommendations urged
by the Local Government Board on County Councils and County Borough Councils to provide
necessary facilities for diagnosis and treatment lor all, with a promise of 50% net grant on
approved expenditure.
In 1921, "Sanatorium Benefit" ceased to be a benefit under National Health Insurance;
and the Public Health (Tuberculosis) Act, 1921, required all County and County Borough
Councils to make adequate arrangements for tuberculous persons—and also permitted them to
assist in after-care schemes.
So far, no hint of any compulsory measure in dealing with the disease is seen (with the
exception of the onus of notification by the doctor): but in the Public Health Act, 1925, power
was given to the authorities to apply to court for Orders to remove to institutions, under certain
specified circumstances, tuberculous persons likely to be a danger to the community from the point
of view of infection.
By the Public Health (Prevention of Tuberculosis) Regulations, 1925, employment of
persons suffering from phthisis—or tuberculosis of the respiratory organs—was prohibited in
various branches of the milk trade.
All the earlier regulations (notification, etc.) were consolidated in the Public Health
(Tuberculosis) Regulations, 1930: and the Local Government Act, 1929, simplified institutional
treatment by handing over care of those tuberculous persons (formerly in hospitals controlled by
the Guardians) to the local authorities for tuberculous schemes, hence removing the disadvantage
of dual control.
In 1919, the Local Government Board was replaced by the Ministry of Health and the
latter institution has had an important influence upon the prevention and treatment of the
disease. Health Services were co-ordinated and a special medical department in the Ministry
was organised to deal solely with tuberculosis. Certain memoranda 37T and 37T (revised) were
issued in 1925 and 1930 by the Ministry of Health formulating a comprehensive and uniform
system of records for use throughout all Dispensaries.
The system of record and procedure is now adopted universally in England and Wales
and has proved to be most efficacious in dealing with the tuberculous population, many of whom
are not permanently resident in one district but move away for various reasons.
Returns of all dispensary work are furnished yearly to the Minister of Health and to the
Chief Medical Officer of the Local Authority for tuberculosis, by the Medical Officer of Health
of the Borough.
(Within the administrative County of London, this Local Authority is, of course, the
London County Council).
In addition to the above, an optional return can also be submitted dealing with the after
histories of patients. This is designed to arrive at some conclusion as to the value of the
tuberculosis service in relation to prolongation of life or cure of the disease.