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52
THE METROPOLITAN ASYLUMS BOARD.
Under the provisions of the (now repealed) Sanitary Act, 1866 (sec. 37), the local sanitary
authority was endowed with power to provide, for the use of the inhabitants within their district,
hospitals for the reception of the sick; a provision re-enacted in section 75 of the Public Health
(London) Act, 1891. But, excepting in a few districts, and for a limited period, in time of emergency;
e.g., when small-pox was epidemic, this power was not exercised, despite official pressure
brought to bear to induce sanitary authorities to erect local hospitals. The late Vestry led the
opposition to the establishment of such hospitals, with little support at first, but ultimately with
complete success; and no one now doubts that the policy of that body, adopted in 1877, was wise,
and fruitful in benefit to the entire Metropolis. In 1867, the Metropolitan Poor Act brought
the Asylums Board into existence, and this body soon set to work to provide infectious disease
hospitals for the "sick poor," i.e., paupers. As a matter of fact, however, and despite the disabilities
attaching, in theory, to the use of these hospitals, they were largely used from the beginning
by non-paupers; and in course of time legislation gradually secured to the inhabitants
of the Metropolis all the advantages desired and contended for by the late Vestry. The hospitals
are now free to all, no disability of any kind attaching to the use of them by any person whatsoever.
The Managers, as the central authority, have fulfilled their duties admirably, and have
created for London a hospital system unequalled elsewhere, and which, it is perhaps not too
much to say, is the admiration of foreign nations. Be this as it may, the Managers fulfil the
duties originally devolving upon local sanitary authorities; duties which those authorities would
undoubtedly have had to perform but for the creation of the Board, and the subsequent legislation
which has so enhanced their powers as to leave almost nothing to be desired. During
the past year more than one of the Borough Councils approached the Managers with a suggestion
that they should provide accommodation for poor persons suffering from consumption, and it
will have been observed that the Conference of Metropolitan Guardians, held in October, 1899
(see page 40), regarded the Managers as the proper authority to act for them in fulfilment of
this duty—for it is nothing less. The Managers have expressed willingness to assume the
position of hospital authority for this purpose, should the local authorities be anything like
unanimous in the desire to see it entrusted to their hands, and it is to be hoped that ere long
some joint action may be taken by the sanitary authorities to bring about such a desirable new
departure. But whether the work be done by the Board at the instance of the Poor Law or the
Health Authorities, the assistance to be afforded to poor sufferers from this dire disease must
be dissociated from poor " relief " in the legal sense of the expression.
Report of the Hospitals Committee for 1900.—Prior to 1898, the work of the Asylums
Board was summarised annually in three reports, prepared respectively by the Chairman of
the Board, the Ambulance Committee, and the Statistical Committee. The three reports overlapped
in many directions. For 1899 a single report, issued by the Statistical Committee, covered
the entire ground. The report was comprised in two volumes, the second of which, dealing with
matters relating to the work of the Managers as the Hospital and Ambulance Authority of London,
has naturally the greater interest for sanitary authorities. In 1900, a further development
took place, a Hospitals Committee having been appointed, presumably with the intention of
unifying administration at the several institutions of the Board. The first report—at present
the one only report—-of the new Committee deals with a period of 18 months ended December,
1900. To this report various appendices are attached, and among them "extracts from the
Annual Report of the Statistical Committee for 1900." In the absence of information relating
to the year 1901, a short resume of the report for 1900 may be not without interest as an indication
of the magnitude and importance of the work of the Board.
Notification Statistics show that during the year 1900 there were notified in the Metropolis
35,247 cases of infectious disease (compared with 42,825 cases in 1899),* of which 30,243 (36,338)
were legally admissible to the Managers' hospitals, and 21,361 (24,732), or 70.63 (68.08) per
cent. were admitted. In no previous year had the proportion of admittances to notifications
been so great. In 1890 the proportion was only 33 59 per cent. The increase in the ratio of
diphtheria to scarlet fever again shows further progress. In 13 (7) districts the number of
diphtheria notifications exceeded those of scarlet fever. Tables are given which show the great
variation from week to week in the percentages of cases admitted to hospital; ranging from 65.32
(63.05) to 85.40 (87.40) in the case of scarlet fever; from 62.23 (56.91) to 87.91 (83.55) in the case
of diphtheria, and from 35 00 (20.63) to 65.57 (75.00) in the case of enteric fever. The Committee
observe that the proportion which the hospital admissions bear to the total number of cases is of
great importance to the Managers in considering the question of the amount of accommodation
which should be provided to meet the wants of the Metropolis, and they give for each of the
years 1890-1900, inclusive, a table showing the percentage of admissions to notifications of each
admissible disease. The proportion of scarlet fever admissions has risen from 42.82 to 7515; of
diphtheria cases from 17.87 to 72.48; and of enteric cases from 22.49 to 47.70; a very satisfactory
state of affairs, from the public health point of view. Enteric fever was more prevalent in the
years 1899 and 1900 than in any previous year since the introduction of compulsory notification.
The Committee observe that, notwithstanding a more than double increase in accommodation for
fever cases since 1891, it may still become necessary to make further provision, as the present
accommodation would prove inadequate should scarlet fever and diphtheria again become as
prevalent as they were in the year 1893 [an observation which naturally could not take count of
* Note that italic figures in brackets are the corresponding figures for 1899.