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70
THE METROPOLITAN ASYLUMS BOARD.
L nder the provisions of the (now repealed) Sanitary Act, 1866, the local sanitary authority
was endowed with power to provide, for the use of the inhabitants of their district, hospitals for
the reception of the sick; a provision re-enacted in section 75 of the Public Health (London) Act,
1891. But, excepting in a few districts, and for limited periods in time of emergency; e.g., when
small-pox was epidemic, this power was not exercised, notwithstanding official pressure brought to
bear to induce sanitary authorities to erect local hospitals. The late Vestry originated opposition
to the establishment of such hospitals; and no one now doubts that the policy of that body was
wise, and fruitful of benefit to the entire Metropolis. In 1867 the Metropolitan Poor Act brought
the Asylums Board into existence, and this body set to work forthwith to provide infectious disease
hospitals, nominally for paupers only. As a matter of fact, however, and despite the disabilities
attaching, in theory, to the use of the hospitals, they were largely used from the beginning by
non-paupers; and in course of time legislation secured to the-inhabitants of the Metropolis all of
the advantages contended for by the late Vestry, at my instance, from 1877 onwards. The hospitals
are now free to all, no disability attaching to the use of them. The Managers have carried out
their work admirably, and having created for London an unequalled hospital service, fulfil the
duties originally devolved upon the local sanitary authorities; duties which those authorities
would undoubtedly have had to perform but for the creation of the Board; and the subsequent
legislation which has so enhanced their power as to leave little to be desired.
The Annual Report of the Board for 1904 (that for 1905 not having been issued yet)
is a document of great interest to Public Health and Poor Law Authorities—and to all
ratepayers—by reason of the importance of the duties devolved upon the Managers, and the
magnitude of their expenditure, which amounted to £1,196,795; viz., £1,002,198 on current
aocount (including for Asylums, £211,224; Hospitals, £344,451; Ambulance Service,
£36,053—Land, £23,378, River, £12,675—Children's Homes and Schools, £53,875; Training
Ship, £17,711General Expenses," £338,777); and £194,597 on loan account; the total
amount borrowed to Michaelmas, 1904, for land, buildings, fittings and furniture, being
£5,332,125 ; the amount outstanding at that date being £3,544,592. The precepts levied by
the Managers on the constituent parishes and unions of the district for the year, work out
at 6d in the £, the same as the average for the preceding five years.
The Institutions administered by the Board comprise 15 hospitals for infectious
disease; a land ambulance service (8 stations, 171 ambulance and other vehicles), a river
ambulance service (3 wharves and 5 steamboats), 5 asylums for imbeciles; a training ship;
2 schools for children with ringworm; 2 schools for children with ophthalmia; 3 sea-side
homes for children; 5 homes for defective children, and 3 homes for children remanded by
magistrates; making with the central stores and central needle-room, and the offices of the
Board, a total of 49 institutions; one hospital for convalescing fever patients, and one
asylum for imbeciles, being in course of construction.
The Board's property comprises an area of 1,507 acres.

Ambulance Work.—Land Service.—Infectious patients removed to or from home to hospital :
fever, 18,468; small-pox, 494; other infectious removals, 10,999. Conveyance of Imbeciles
and other persons, 1,273; Total removals, 31,798; Mileage run by vehicles, 250,352.
River Service.—Patients conveyed down the river to the smallpox hospitals, 437; other
passengers conveyed to and from the hospitals, including recovered patients, 1,219; Total
passengers, 1,656: Miles run by steamboats, 11,604.
* Metropolitan cases only.
† Including extra-Metrcpolitan cases.