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The motion was lost, and the Board ordered—
" That the Kensington Borough Council, and the Chelsea, Holborn, and Poplar Guardians
be informed that in the absence of unanimity of opinion among the authorities of the
Metropolis the Board has adjourned for twelve months the question of the provision of accommodation
for persons suffering from consumption."
In the last report for 1902, commenting on this decision, I reminded the Council that the
Managers, as to three-fourths of their number, are the nominees of the Boards of Guardians, and
that the representatives of those bodies had well considered the subject at the conference held in
1900. At that conference, as already stated, 26 boards, out of 32 in the metropolitan district, were
represented by 77 delegates, who, by an unanimous resolution, declared that the time had come
when provision should be made for the open-air treatment of " the sick poor " (that is the pauper sick)
of the Metropolis, suffering from consumption: it could hardly be said, therefore, so far as the
"authorities" who elect the Managers are concerned, that there was not a general consensus of
opinion in favour of the Board undertaking the duty. The matter, moreover, is one that primarily
concerns the Poor Law authorities; and the importance of it will be understood when it is stated
that the Medical Inspector of the Local Government Board, who was present, unofficially, at the
conference, informed the delegates that on July 7th, 1900, there were 1,562 consumptive patients in
"Metropolitan institutions" (Workhouses and Infirmaries), of whom 1,000 could be moved to a
sanatorium or sanatoria within fifty miles of London ; and, of these, 400 were in the initial (and
therefore curable) stages of the disease.
In the same report (No. 13, 1902, page 229), I further observed that it was "a terrible
reflection that there should be so many sufferers in unsuitable institutions in London—
a misery to themselves and a danger to their fellow inmates—who might be transferred to sanatoria
in the country, where beyond question, many would be restored to health and usefulness, and all
would cease to be a danger to other persons.*"
The report continued as follows :
" If the Boards of Guardians share the views of their delegates, it is to be hoped that they
will ere long approach the Local Government Board, and instruct the Managers, who represent
them to take steps to obtain power enabling them to undertake the proposed duty. The
Managers are known to be willing to do so—but it is unfortunate that they are unwilling to
take the initiative, preferring to await the mandate of their constituents. The Sanitary
Authorities, it need hardly be said, are not represented on the Board.
" The work cannot be undertaken without legislation; excepting, perhaps, for the poor in
receipt of relief, under Section 5 of the Metropolitan Poor Act, 1867. The Local Government
Board would be the proper authority to introduce a Bill. They appear to be favourable
to the proposal, and probably only wait for a clear indication of the views in its favour, of the
Sanitary and Poor Law Authorities. The Conference, it may be repeated, was convened
with the approval of the Board, if not at their instance.†
" The Asylums Board, appointed under the Metropolitan Poor Act, 1867, for the purpose
(inter alia) of providing hospitals for ' the sick poor' (i.e., the pauper sick) of the Metropolis,
were originally authorised to provide such accommodation for ' small-pox and fever' only.
Subsequently, and as the result of a movement in which the late Vestry took no secondary
part, the Managers were enabled by Parliament to receive cases of diphtheria into their institutions,
and, further, to ' admit any person who is not a pauper,' suffering from either of
the diseases named.
" These powers were conferred by The Poor Law Act, 1889, Section 3 of which reads as
follows: —
3. (1) The managers of the metropolitan asylum district (hereinafter referred to
as the asylum managers), subject to such regulations and restrictions as the Local Government
Board from time to time make, may admit any person who is not a pauper, and is
reasonably believed to be suffering from fever or small-pox or diphtheria, into an asylum
provided by the managers.
* " The fight with tuberculosis , . , must aim at shutting off the chief, indeed we may say almost the only, source
of infection. This is those consumptives who, in consequence of the unfavourable conditions under which they live, or because
they obstinately set aside the simplest rules for the prevention of infection, are a danger to their companions In some way or
other we must look after these sick people, either by procuring for them more favourable conditions ; for example, as regards
dwelling-places, or by so sheltering them in suitable institutions that they cease to be a danger to their neighbours."—Address
by Robert Koch, M.D., delivered at the International Conference on Tuberculosis in Berlin, l902.
† " Correspondence was read at the Conference, showing that the Local Government Board, on the matter having been
brought before them, expressed sympathy with the Managers of the Poplar and Stepney Sick Asylum District (to whose
initiative the holding of the Conference was due), in regard to provision being made for the open-air treatment of phthisis, but
intimated their opinion that such provision, if made at all, should be for the Metropolis, as a whole, and be under the management
and control of a Metropolitan authority. The Board also suggested the holding of a Conference of Metropolitan Poor
Law Authorities " (vide No. 10 Report, October 16th, 1900, p. 107, based on a report of the proceedings of the Conference in
The Standard).