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Resolutions of four County Councils extending tlie provisions of the Act to pulmonary
tuberculosis, have been approved by the Local Government Board, but I am not aware that
any County Council has yet formed a "hospital district" with a view to the isolation of
phthisis. It is not improbable that County Councils generally, and sanitary authorities
likewise, may be unacquainted with the extent of their powers, and that their inaction is
largely due to this circumstance. Be this as it may, if only the County Councils, the sanitary
authorities, and the Boards of Guardians could be made to appreciate the importance of
the matter, and, under the stimulus of the Local Government Board, to exercise their statutory
powers, the land might, ere long, be studded with sanatoria bearing some reasonable
proportion to the greatness of the need.
As regards the Metropolis, under the Public Health (London) Act, 1891 (Section 75),
sanitary authorities possess the same powers, qua provision of hospitals, as extra-Metropolitan
sanitary authorities. But there should be no occasion for the exercise of them, London
having in the Metropolitan Asylums Board a central hospital authority admirably
qualified for the work. The Managers have been pressed, again and again, to undertake
the duty, by Public Health and Poor Law authorities alike, by the Metropolitan medical
officers of health, and by the National Association for the Prevention of Consumption. They
are sensible of the importance of the matter; and, recognising the "widely spread movement
amongst public authorities for some special provision for consumptive cases," they have
lately established a seaside Home ("Millfield") at Rustington, near Littlehampton, for one
hundred chargeable children under sixteen years of age, "suffering from pulmonary tuberculosis
in its early stages."
To enable the Managers to provide sanatoria for chargeable adults, an Order of the
Local Government Board would appear to be all that is necessary; and probably this might
be had for the asking; but an Act of Parliament would be required to enable the Local
Government Board, by an Order, to authorise the Managers to provide for non-chargeable
sufferers.
It is to be hoped that the Managers will see fit, ere long, to apply for an Order, and that
an Act may be obtained by the President of the Local Government Board,* himself a convinced
believer in the open-air treatment, which he has done not a little to promote.
I come now to a consideration of the movement which has brought about that "general
consensus of opinion amongst the Metropolitan authorities" desired by the Asylums Board
as a condition precedent to their undertakng the care of patients suffering from consumption;
or, in other words, to their becoming the sanatorium authority for the whole Metropolis.
The primary impetus may be said to have been given by the formation, under the
auspices of His Majesty King Edward VII., when Prince of Wales, of the National Association
for the Prevention of Consumption, one of its objects being "to promote the erection
of sanatoria for the open-air treatment of tuberculous disease."
The first to move in the matter were the Managers of the Poplar and Stepney Sick
Asylum District, who, in 1900, waited upon the Local Government Board to ask for authority
to establish a separate hospital for the treatment of their consumptive patients. The
Board, whilst expressing sympathy with the object, deprecated individual action, the question,
in their opinion, "having a Metropolitan rather than a local character"; so that "provision,
if made at all, should be for the Metropolis, as a whole, and be under the management
and control of a Metropolitan Authority." The Board furthermore suggested that a
Conference of representatives of the Poor Law authorities "should be invited to meet and
discuss the subject, and in the event of such Conference considering the provision of the
proposed accommodation desirable, it should address the Board, and thus give the views of
the Metropolis generally on the question."†
The Managers convened a Conference (held in October, 1900), at which twenty-six out
of the thirty-two Boards of Guardians were represented, and to which representatives of
the National Association and other experts were invited. Dr. Downes, medical inspector
of the Local Government Board (for Poor Law purposes), who was present, but not in an
official capacity, gave the Conference much valuable information, stating, among other things,
that on July 7th, 1900, there were 1,300 patients suffering from consumption in Metropolitan
institutions (that is, parochial infirmaries and workhouses), of whom 1,000 could be
moved to a sanatorium within fifty miles of London; and that of the total number, 400 were
in the initial stage of the disease; that the deaths from tuberculosis in those institutions in
1899, were 3,000, including 2,800 from consumption; or 33 per cent. of the total mortality
*The reference was to the Right Hon. Walter Long, who ceased to hold that important office in March of the
current year.
†The quotations in the text are from the letter addressed by the Clerk to the Managers to the several Boards of
Guardians, when convening the Conference.