Under the National Insurance Act the annual sum of 1s 3d (30 cents) was set apart for each insured person; as the result of subsequent bargaining with medical practitioners 6d of this was devoted to the domiciliary treatment of tuberculosis patients (payable on the number of panel patients on each doctor’s list, not on the number of his tuberculous patients), the remainder being payable to local authorities who undertook the provision of institutions for the treatment of tuberculous insured patients.
Thus the “Sanatorium Benefit” comprises
A. Domiciliary treatment.
B. Institutional treatment.
(a) Non-residential—Dispensaries.
(b) Residential—Sanatoria,
Hospitals,
Convalescent Homes and
“Farm Colonies.”
Soon after the passing of the National Insurance Act in 1911 representations were made that tuberculosis affected non-insured as well as insured; that treatment of insured could have only partial success so long as non-insured members of the same household were neglected; and that this was work for public health authorities which they were already partially undertaking. It was evident that the inextricably interlaced measures for the prevention and the treatment of tuberculosis must accrue to the whole population; and the mistake of the National Insurance Act was remedied to the extent that Public Health Authorities were informed that the National Treasury was prepared to pay one-half of the approved expenditure incurred by these authorities in establishing schemes for the treatment of tuberculosis available for the entire population. Such schemes were proceeded with, as already indicated; but there remained the fact that insured persons who had paid their weekly quota and were therefore entitled to “Sanatorium Benefit” usually interpreted this as a right to three months’ treatment in a Sanatorium. The choice of persons to receive treatment in a Sanatorium lay with Local Insurance Committees appointed under the National Insurance Act, who generally acted on the advice of the tuberculosis officer; but influences other than medical led to the unsatisfactory use of institutional treatment. A large number of patients were sent to and retained in sanatoria for prolonged periods, who might have been adequately treated at home, or who should have been in hospitals. Satisfactory results for sanatorium treatment were not secured under these conditions; and there will probably be no material improvement until the Sanatorium Benefit is withdrawn as a special benefit under the National Insurance Act, and the treatment of tuberculosis becomes an obligatory duty of Public Health Authorities, with a minimum standard of provision to which all must attain.
Residential Institutions
The extent to which these have been provided in England since 1911 has already been stated. The number of beds available in 1917 was 12,441, in addition to some 9,000 beds in poor-law institutions, which in 1911 were occupied by consumptives. From the point of view of the provision required in residential institutions for the treatment of tuberculosis the following classification is useful. It is confined to pulmonary cases:
Group A—Cases in which permanent improvement or
recovery can usually be anticipated.
Group B—Cases in which only temporary, though
possibly prolonged, improvement may be