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The National Aspect of the Movement.—The work of sanatorium provision, by whatsoever
body or bodies undertaken, is clearly cne of National importance, and if evidence were wanting
of the beneficial results likely to accrue from the adoption of my proposal, reference might be
made to the experience of Prussia. In that country all workers are required to insure their
lives, and the insurance companies have found it worth their while to establish sanatoria for
sufferers from consumption—to the extent of 7,000 beds. The average duration of stay in
hospital of each patient is three months, some 30,000 cases being admitted in the year. The
time spent in hospital is devoted not merely to treatment, but also to educative work, the
sufferers being taught how to manage themselves, and carry on their "cure," after leaving. It
is stated, on authority, that 87.7 per cent. of the cases are "cured," or improved in health;
67.3 per cent. of them so as to be fully restored to work; another 7.1 per cent. becoming fully
capable of work, other than that of their previous occupation, whilst 14.6 per cent. become
capable of partially resuming work. Only 11.0 per cent. leave the hospitals in a state so as
not to be able to earn their living.0
The Legal Aspect of the Case. It having been asked, whether the Managers could give
effect to my views under existing circumstances? I have no hesitation in saying that, as regards
the chargeable poor, they possess the power, under section 5 of the Metropolitan Poor Act, 1867,
which authorises them to provide Asylums for "reception and relief of the sick, insane, or infirm,
or other class or classes of the poor chargeable in unions and parishes in the Metropolis."
The Case as to Non-chargeable Persons. As respects the non-chargeable poor, presumably
legislation would be necessary, as it was held to be (in 1889) to enable the Managers to undertake
the treatment of persons suffering from diphtheria—an extension of their work which the late
Vestry, acting upon my advice, were largely instrumental in bringing about. The necessary Bill,
would probably meet with but little, if any, opposition if introduced, as doubtless it would be, by
the President of the Local Government Board.
The Medico-legal Status of Consumption. In connection with the question of legality, the
Council may be reminded that the Local Government Board, in a communication to the National
Association for the Prevention of Consumption, summarised in the Times of 23rd May, made it
clear that phthisis comes within the definition of an "infectious disease," and that provision may be
made for persons suffering therefrom under the Isolation Hospitals Act, 1893, an Act " for enabling
county councils" (other than the London County Council) "to promote the establishment of
hospitals for the reception of patients suffering from Infectious Diseases." [The Act does not
apply to the Metropolis, for the simple reason that long before it was passed, the powers conferred
by it on Provincial County Councils, had been exercised by the Metropolitan Asylums Board.]
The Board stated that the provisions of the Act "may be applied to any other infectious diseases"
than those that are notifiable, in like manner "as if a county council were a local authority under
the Act relating to the notification of infectious disease." And that, "although pulmonary
tuberculosis is not one of these diseases, the provisions of the Act may, under section 26, be applied
to that disease," by an order of the County Council, which, however, "requires the approval" of
the Board. It may be assumed, therefore, that the Board would be prepared to give their approval,
should the Managers desire authority for undertaking the care of persons suffering from consumption;
and in this connexion it may be repeated that not only is the President of the Board in sympathy
with efforts to provide Sanatoria, but also that the Board have, on more than one occasion,
sanctioned the making of such provision for the chargeable poor.
The duty, which the Managers are invited to assume, is thus seen to be cognate to the work
they have, since 1870, performed, in respect to other infections diseases, with so much advantage to
the public health interests of London.
The Question of Local Hospitals.—The Sanitary Authorities might, singly, or in any degree of
combination, provide hospitals for the inhabitants of their several districts under the power conferred
by the Public Health (London) Act, 1891, section 75 cited above (page 37). No action has hitherto
been taken to exercise this power, though some of the South-Eastern Borough Councils made an
attempt to form such a combination. It fell through however; and it may be doubted whether any
arrangement of the sort would prove satisfactory, or be permanent.
* The statistics cited were published in The Times, 21st October, 1903, in an article on "Industrial Conditions in
Germany."