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76
THE METROPOLITAN ASYLUMS BOARD.
Under the provisions of the (repealed) Sanitary Act, 1866 (sec. 37), the local sanitary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, nominally for paupers only. 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 secured to the inhabitants of the Metropolis all the
advantages desired and contended for by the late Vestry, at my instance, from 1877 onwards. The
hospitals are now free to all, no disability 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 the 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 little or nothing to be desired. During the past year, and
in 1901, several of the Borough Councils approached the Managers with a suggestion that they
should provide accommodation for poor persons suffering from consumption, a subject dealt with
elsewhere, and it will have been observed that the Conference of Metropolitan Guardians, held in
October, 1900 (see page 49), regarded the Managers as the proper authority to act for them in the
fulfilment of this duty—for it is nothing less. The Managers are understood to be willing to
assume the position of hospital authority for this purpose, should the local authorities be
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 Guardians,
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 Statistical Committee.—In the absence of information relating to the
Hospital and Ambulance Work of the Board for 1902—the report not yet being published—a
resume of the report of the Statistical Committee for 1901 may not be without interest, as an
indication of the character and magnitude of the work of the Managers in respect to infectious
disease.
Notification Statistics show that during the year 1901 there were notified in the Metropolis
40,361 cases of infectious disease (compared with 35,247 * in 1900), of which 35,501
{30,24.3) were legally admissible to the Managers' hospitals, and 26,521 (21,371), or 74.7
(70.63) 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. For the first
time for some years there was a decrease in the ratio of diphtheria to scarlet fever, notwithstanding
that the number of diphtheria notifications exceeded those of scarlet fever in 3 (13)
different districts, viz., Fulham, Hackney and Poplar.
Tables are given which illustrate the great variation from week to week in the percentages
of cases admitted to hospital, ranging from 61.80 (65.32) to 91.02 (85.40) in the case
of scarlet fever; from 58.28 (62.23) to 92.02 (87.91) in the case of diphtheria; and from
25.00 (35.00) to 65.91 (65.43) in the case of enteric fever.
Small-pox.—Practically all cases of small-pox find their way into the Managers' hospitals,
less than 3 per cent. of the cases notified in the year being treated elsewhere. Frequently the
small-pox admissions exceed the number of notifications, a fact probably explicable in many
instances by the " disinclination of medical practitioners to send their certificates to the
Medical Officers of Health until they know whether the diagnosis has been confirmed by the
Board's experts."
Percentage of Admissions to Notifications.—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 1890-1901 a
table showing the percentage of admissions to notifications of each admissible disease.
* Note that the italic figures in brackets are the corresponding totals for 1900.