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The Need of a Central Authority.—The work, indeed, is one that can be carried out, effectively,
only by a Metropolitan Authority, as the Local Government Board plainly intimated to the promoters
of the Poor Law Conference of 1900. Were hospitals provided by a single Sanitary Authority,
or a combination of such Authorities, it is more than probable that persons suffering from consumption
would flock to the district from all parts of the Metropolis in the hope of getting admitted:
surely an undesirable effect of what could not be described, otherwise, than as a legal and commendable
course of proceeding, were it reasonably practicable.
The desiderated "General Consensus of Opinion" Attained.—It has long been believed that the
Asylums Board are willing to take up the work and have only been waiting for evidence of a
"general consensus of opinion on the part of the Metropolitan Authorities" before approaching the
Local Government Board on the subject. In their annual report for 1902, after referring to the
"diversity of opinion" amongst the Board of Guardians, as to the desirability of the Board undertaking
the treatment of the tubercular disease Lupus, they went on to state that" there was a
nearer approach to unanimity on the part of the Boards of Guardians, as well as on the part of the
Sanitary Authorities of the Metropolis, on the suggestion that the Board should provide Sanitoria for
Consumption." Surely the "consensus of opinion" is now "general" enough to satisfy the Managers
and the Local Government Board, alike! Reference has already been made to the unanimity of the
Poor Law Conference. May it not now suffice, that Public Health Authorities such as those of St.
Pancras, St. Marylebone, Lambeth, Poplar, Shoreditch, Battersea, Finsbury, Fulham, Stepney, Stoke
Newington. Kensington; and Boards of Guardians such as those of Paddington, Chelsea, Hammersmith,
Holborn, Poplar, Stepney, Wandsworth and Clapham, and Kensington, endotse the views
of the Council and have invited the Board to undertake the proposed duty? Only two Borough
Councils expressed dissent to the proposal, and one Board of Guardians. Some authorities—Poor
Law and Public Health—who decided to take no action, cannot be deemed unfriendly to the movement—certain
of them, indeed, expressed approval of the principle; whilst others who did not reply
to the Council's letter, may be regarded as, at least, not hostile. And lastly, be it remembered that
the Medical Officers of Health of the City and County of London, competent judges, surely, are
unanimous in their desire that the Managers should become the Sanatorium Authority.
It will be a great and notable day for London should the Asylums Board be enabled by the
Local Government Board to avail themselves of this superb opportunity of adding to the benefits
they have already, in so many ways, conferred upon the inhabitants of London.
NOTIFICATION OF CONSUMPTION.
Towards the close of 1901, the Council having adopted my recommendation to make
pulmonary phthisis voluntarily notifiable, I was authorised by the Public Health Committee to
employ the services of the lady inspectors in an enquiry into the circumstances of the cases notified.
The work, inaugurated in 1902, and continued in 1903, is still in progress.
The report of the Inspectors for 1903 was printed in the first report for the current year with
appended tables showing distribution of cases in wards, etc., sex and age of cases notified, and of
non-notified fatal cases, together with a variety of other interesting information, as "Status of the
sick," "Rooms occupied," "Disinfection," etc. The cases investigated were 221 in number
(compared with 247 in 1902) of which 66 proved fatal. Inquiry was made also with regard
to 26 deaths of persons whose cases had been notified in 1902, and to 127 deaths of persons
whose illness had not been notified. The total cases investigated were 374 (males 218, females
156) 276 in North Kensington and 98 in South Kensington. The 276 cases in North
Kensington occurred in wards as follows:—St. Charles 36, Golborne 73, Norland 138 and
Pembridge 29 : the 98 cases in South Kensington, in Holland Ward 34, Earl's Court 11,
Queen's Gate 28, Redcliffe 14 and Brompton 11.* Forty-seven of the cases notified were of persons
resident at 21 common lodging-houses, the largest number being respectively 7, 5 and 4 in
one house each, and 3 cases in each of two houses. The report gave information with regard to
phthisical history in persons and families, and proximate causation of illness. It is satisfactory to
note that in the majority of houses visited, the rooms occupied by the sufferers were found fairly
clean and ventilated; a distinct improvement being noted (compared with the previous year) as
regarded ventilation by open windows, and an increased appreciation of the value of fresh air to
consumptive persons, as also of the danger arising from indiscriminate spitting. In each case visited,
instructions were given to the patient, or the relatives, enjoining the necessity of wet cleansing of
rooms, furniture, etc., and with respect to the treatment of sputa, and the Council's leaflet on 'The
Cause and Prevention of Consumption' was also left at each infected house, together with a
* The population of the wards is set out in the table at page 5.