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the resolution, unanimously adopted, affirming the necessity for the "open-air" treatment of Consumption.
It was the view, moreover, of the Conference of Delegates of the Metropolitan Borough
Councils,* held at the County Hall in July, 1904. The Delegates, at both Conferences, concurred
with the opinion expressed by the Local Government Board, prior to the first Conference, that
the provision of sanatoria was a matter which, "if dealt with at all, should be dealt with by a
Metropolitan Authority"—the Authority indicated at both Conferences being the Metropolitan
Asylums Board. In the interval between the two Conferences, the Asylums Board were requested
by many of the Public Health and Poor Law Authorities to assume the function of Sanatorium
Authority—mainly at the instance of the Councils of the boroughs of Chelsea, Bermondsey, and
Kensington.† The National Association for the Prevention of Consumption cordially endorsed
the proposal, which received the unanimous support of the Metropolitan Medical Officers of
Health. The (then) President of the Local Government Board, moreover, was known to be a convinced
believer in the. "open-air" treatment, which he had done somewhat to foster by favouring the
provision of sanatoria by Boards of Guardians.
The Metropolitan Asylums Board have taken theoretical interest in the question for a
long time. In 1901 they would have undertaken the treatment of the tubercular disease LUPUS,
had the consensus of opinion of the Boards of Guardians in regard to the matter been more
general; and in November, 1902, they manifested willingness to entertain favourably the request
that they should become the Sanatorium Authority for London—on assurance being forthcoming
that there was a "general consensus of opinion among the local authorities" in support of the
proposal. The Managers, moreover, have conceded the principle involved in the proposal, by
establishing at East Cliff, Margate, and at Rustington, near Littlehampton, Seaside Homes for
Children, for the treatment of surgical and medical cases of Tuberculosis, respectively. It was
hoped, and expected, therefore, that, the desired "general consensus of opinion" having been
attained, the Managers—when consideration of the subject, after twelve months' postponement,
was resumed in November, 1903—would have applied to the Local Government Board for the
necessary powers. But, whilst recognising the "vital and far reaching importance of the pro"posal
to the community at large," they resolved to take no further steps in regard to it without
an "authoritative expression of opinion by the Chief Health Authority of the country, the Local
Government Board." This decision was communicated to the Local Government Board, and to the
local authorities, in December, 1903. The Board have not yet announced their views, having, in
fact, informed the Managers, in June last, that they were "obtaining information on the whole
subject," and were not then" in a position to express an opinion on the question as to
whether the Managers should undertake the new duties suggested."
Such being the present state of affairs, it becomes an interesting question whether there
are any indications as to the nature of the "opinion" likely to be expressed by the Board? I
think there are, and that they are of a hopeful tendency. In support of this view reference may
be made to the Board's suggestion for the holding of the Poor Law Conference in 1900. In
1903 the Board informed the National Association for the Prevention of Consumption that the
Isolation Hospitals Act, 1893, which enables County Councils (other than the London County
Council) to take measures for promoting the provision, by groups of sanitary authorities, of hospitals
for infectious diseases, was applicable to phthisis (consumption), though this disease is
not named in that enactment; and in July, 1905, the Board informed the Bath Union Board of
Guardians—who had consulted them "with reference to the detention in the workhouse of paupers
suffering from phthisis",—that, "if the advanced phthisis from which a workhouse inmate is
"suffering is 'pulmonary tuberculosis' with expectoration," it may be regarded as an infectious
disease within the meaning of Section 22 of the Statute 30 and 31, Vict. c. 106—so that, in other
words, the person might be detained as if he were suffering from one of the infectious diseases
admissible to the hospitals of the Metropolitan Asylums Board. The Board, moreover, entertain
favourably applications by Boards of Guardians for sanction to expenditure on provision of
separate accommodation for consumptives in Poor Law institutions, and on sanatoria.
Reference may also be made to certain unofficial expressions of opinion on the Sanatorium
question by the Board's Medical Inspectors. Thus, at the Poor Law Conference in 1900, Dr.
Downes, the Chief Inspector for Poor Law purposes, expressed the view that, if sanatoria should
be established without the Metropolis—and he was favourable to it being done—they should be
* "On the Administration of the Public Health (London) Act, 1891."
† A list of the authorities assenting, and dissenting, approving the principle, or neutral, was given in the report of the
General Purposes Committee of the Asylums Board, dated 23rd November, 1903.