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(2) The expenses incurred by the asylum managers for the maintenance of any such
person shall be paid by the guardians of the union from which he is received, and those
guardians may recover the amount of those expenses as a simple contract debt from the
said person or from any person liable by law to maintain him.
(3) The said expenses, so far as the same are not recovered by the guardians, shall
be repaid to them out of the Metropolitan Poor Fund.
(4) After the date of an order of the Local Government Board authorising the
asylum managers to receive diphtheria patients into their hospitals, sub-section two of
section sixty-nine of the Metropolitan Poor Act, 1867, shall apply as if diphtheria were
therein mentioned as well as fever and small-pox.
" The Section and Sub-section of the last-named Act read as follows: —
69. Expenses incurred for the following purposes after the 29th day of December,
1867, shall be repaid out of the Common Poor Fund—that is to say
(2) For the maintenance of patients in any asylum specially provided under this Act
for patients suffering from fever or small-pox.
" The Local Government Board forthwith, on the passing of the Act of 1889, issued the
necessary order, and thenceforth persons suffering from diphtheria were admitted to the
Managers' hospitals—persons of whatever class—without payment, and without any consequent
disqualification.
" All that would appear to be necessary to enable the Managers to undertake the rare of
persons suffering from consumption, is a single clause Act, based on the precedent of the Act
of 1889. Is it too much to hope that the Local Government Board will, ere long, introduce
such a measure? The President is known to be favourable to the movement*
" In their recent communication the Council expressed an ' earnest hope that the Board
would see their way to advise the Metropolitan Asylums Board to make trial of the plan ' (of
utilising the small-pox hospitals during inter-epidemic periods), ' so that before a large expenditure
be incurred in building special sanatoria, further experience of the benefits expected
to accrue therefrom may be obtained.'
" It is perhaps hardly necessary to observe that no doubt exists as to the benefits that
would accrue from sanatorium treatment. The proposals hitherto brought to the attention of
the Managers contemplate the erection of special hospitals, which would involve not only
legislation, but long delay and enormous cost, whereas the proposal which the Council have
submitted to the Local Government Board, the Managers, the Sanitary and the Poor Law
Authorities, could, with the sanction of Parliament, be brought into operation within a few
months, and without material expense in the adaptation of buildings now lying useless, and
likely to do so for years to come.
" The Managers will, ere long, have in their small-pox hospitals accommodation for 4,000
patients; in the recent epidemic not nearly a half of that number of cases was under treatment
at any one time, and at no one time in the last thirty years have there been 2,000 cases
of small-pox in the hospitals. There is good ground for the expectation that the Metropolis
will be spared another epidemic for many years ; and surely during the interval some portion
of the excessive accommodation available might well be devoted to the isolation and treatment
of consumptives."
The report concluded as follows :—
" Having now put the matter fully, and I hope fairly, before those who alone have power
to translate counsel into action, I take present leave of the subject with the hope that, ere
long, London will be as well provided with the means of helping sufferers from consumption
as those suffering from small-pox, fever, and diphtheria; diseases the mortality from which
is relatively moderate + compared with that due to tuberculosis in its varied forms."
In a preceeding report ‡ the Joyce Green Hospitals (1,750 beds) had been indicated for the
purpose, with the reservation that the remarks made " would be equally applicable should it be
thought desirable to send consumptives to the Gore Farm hospitals." I had thought
Gore Farm might be wanted for scarlet fever and diphtheria convalescents : there was, however,
no need of such accommodation then, nor has any since arisen ; and the Carshalton Hospital for
convalescent cases of this description in course of erection for 800 patients will, it is probable,
ultimately supply all required accommodation.§ But later information, and view of the hospitals,
* " When laying the first stone of the sanatorium which the Guardians of Liverpool and the neighbourhood are erecting
for consumptives" (in October, 1901) the Right Honourable Walter Long, M P., "eulogised the work and promised
that, so long as he presided over the Local Government Board, the Guardians might be sure there would be no restrictive redtapeism
influence, but every encouragement of this kind of work."—Annual Report for 1901 (page 39): quotation from "The
Standard."
† The Registrar-General in his Annual Report, for 1900, gives the deaths from tubercular diseases in England and Wales,
in that year, as 61,302, or 10 4 per cent. of the deaths from all causes, and 1,899 per million of the population, without distinction
of sex. Pulmonary phthisis accounted for 42,897, or 70 per cent., of the above-mentioned deaths ; whilst the deaths from
small-pox, scarlet fever, diphtheria, and enteric fever, in the aggregate, were under 19.000. In that year, it is true that the
deaths from small-pox were only 85. But had the deaths from this cause been as numerous as they were in 1901 or 1902, the
total mortality from all these diseases would still have been considerably less than a half of that from consumption alone.
‡ No. 11, 1902, page 203.
§ This hospital, by its design—detached blocks of buildings, each to contain a moderate number of patients, would itself
be well adapted for a consumption hospital.