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Sanatoria are, indeed, as the International Congress on Tuberculosis, in 1901, declared
them to be, an "indispensable part of the measures necessary for the diminution of tuberculosis;"
and yet it appears that, apart from what little has been done by the Poor Law
authorities, only 2,800 beds have been provided, in about seventy institutions, despite the
strenuous labours of the National Association; whereas for London alone upwards of 2,000
beds have been provided for small-pox, and nearly 6,300 in hospitals for fevers and
diphtheria.
Needless to say, vast sums have been expended in the construction of these unequalled
institutions, and in the maintenance of the 400,000 patients admitted to them since the
Metropolitan Asylums Board began its beneficent work in 1870. But the money has nob
been spent in vain, having regard to the results achieved—typhus practically extirpated;
and, comparing the quinquennia 1899-1903 and 1871-1875, a reduction, after correction
for increase of population, of 87 per cent. in the mortality from the aggregate of the
diseases admissible to the hospitals; 51 per cent. in the case of enteric fever, and 115 per
cent. in the case of scarlet fever, which was the cause in 1903 of only 362 deaths in a population
of more than 4,600,000, as compared with 6,040 deaths in 1870 in a population of
less than 3,250,000.
Praiseworthy efforts are being made in various directions to increase sanatorium accommodation,
but the utmost efforts of philanthropy, self-help, and commercial enterprise
will be found unequal to the task. Consumption being, in the main, a disease of the poorer
classes, who comprise a vast proportion of the population, and are totally unable to pay for
sanatorium treatment, the need will have to be supplied, at the public cost, by sanitary and
Poor Law authorities. But, so far, few of the sanitary authorities have undertaken the work,
whether by the erection of sanatoria for the treatment of curable and relievable cases, or of
refuges for the incurable; and, as regards the 695 unions and parishes in England and
Wales, the Boards of Guardians of 576 of them have done nothing, and the remainder—less
than 18 per cent.—but little in the aggregate compared with the need.
Ireland has a better record, more than one-half of the Boards of Guardians having
made provision for the separate treatment of consumptives, under the stimulus of the Local
Government Board for Ireland, who in 1901, and again in 1903, by the circulation of advisory
letters, posters, and leaflets, impressed upon the Guardians, and all others whom it
concerned, the necessity of isolation.*
In England and Wales the Local Government Board do not appear to have taken any
initiative, but they entertain favourably applications by Boards of Guardians for authority
to expend money in making provision of separate accommodation for consumptives; and
there is no reason to doubt that the same consideration would be extended to sanitary
authorities, and " hospital committees," in counties, in regard to any such applications.
That so little has been done by sanitary authorities, must be attributed rather to failure
to appreciate the importance of the matter than to want of power to cope with it; for outside
the Metropolis these bodies possess power to erect and maintain hospitals for the use of
the inhabitants of their districts, under Section 131 of the Public Health Act, 1875. This
power, exercised hitherto for the establishment of hospitals for "infectious" diseases only—
small-pox, diphtheria, and fevers—is equally available for the building and maintenance of
sanatoria by sanitary authorities, singly or in combination.
The County Councils, moreover (other than the London County Council), are empowered,
under the Isolation Hospitals Act, 1893, to constitute " hospital districts," to appoint
"hospital committees," and to "promote the establishment of hospitals for the reception
of persons suffering from infectious diseases." The provisions of the Act, so the
Local Government Board have informed the Council of the National Association,†" 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 "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
Countv Council, which, however, "requires the approval of the Board."
*The following extract from the circular letter issued in 1901 will suffice to show the spirit in which the Local Government
Board for Ireland approached the matter: "The Board consider that the most necessary step to commence with is to
educate the people in the best means of guarding against the disease and, with this object in view, they would suggest that the
local authorities should endeavour to enlist the sympathy and support of the clergy of all denominations, managers of schools,
schoolmasters, and all persons whose duties bring them intimately in contact with the people, and more particularly with the
poor, and to supply them, for distribution, with copies of the leaflet entitled ' Information for Consumptive People, and for
those who live with them.' The Board would suggest that Boards of Guardians, and sanitary authorities, throughout the
country, would do well to have the posters printed and exhibited in prominent places in their districts, such as the Union Boardroom,
the various dispensary waiting-rooms, schools, and other public places. Copies of the leaflets might also with advantage
be obtained and sent to medical practitioners, clergymen, relieving officers, all sanitary officers and sub-officers, school teachers
and others."
† In a letter dated April 1st, 1903, from which the quotations in the text are made. A fuller abstract of the letter was
printed in my report for 1903 (page 42.)