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adaptation for sanatorium purposes. It has (or will) cost about £300,000, for land (136 acres) buildings,
and furnishing. It has accommodation for about 800 patients, and would probably suffice for 1,000
consumptives. At no distant date, the question of utilising this hospital as a sanatorium (to what
better use could it be put ?) will be brought before the Managers, and should the information then
before the Local Government Board " appear to afford sufficient justification " for the " outlay " involved
in the proposal (there is reason to believe it would not be " very heavy "), it may be reasonably
hoped that the earnest wishes of the Metropolitan Medical Officers of Health, and of the
bodies who supported their Memorial, will have fulfilment.
The Local Government Board for Scotland and the Sanatorium Question.—In the circular
letter to Local Authorities, on the " Administrative Control of Pulmonary Phthisis," adverted to
above (page 44), the Local Government Board for Scotland stated, (under the heading—Isolation
and Treatment) that " the provisions of the Public Health Act as to the removal of cases of infectious
disease to hospital, and as to the provision of hospitals," are " available for dealing with cases of
pulmonary phthisis as with cases of other infectious diseases." That the Board do not think a
" very heavy outlay " necessary is plain, for they go on to say that " in structure Sanatoria may
be of the simplest and cheapest form "—costing, say, £100 per bed. The Board emphasize the
need for isolation of advanced cases. " For this purpose vacant wards of an infectious disease
hospital may be utilised." In London, it will be remembered, that for this class of sufferers provision
to the extent of some 1,500 to 2,000 beds, has been made in separate wards at the Poor Law
Infirmaries.
The Local Government Board for Ireland and the Sanatorium Question.—In my annual
report for 1904, it was stated that " Ireland has a better record," as regards efforts made to deal
with phthisis, than England; " 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 Boards of Guardians, and all others whom it
concerned, the necessity of isolation" for persons suffering from consumption. I am not
aware that any similar official action for spreading knowledge among the people with
regard to consumption—its nature, preventability and possible curability—has been taken in
England. At the same time it may be questioned whether much good would result from official
action which left out of consideration the need for compulsory notification, and for hospitals.
But the economic importance of pulmonary phthisis does not yet appear to be adequately appreciated
; and in England no effectual steps are likely to be taken for its control and treatment, until
it is realized that not only thousands of lives, but also millions of pounds sterling, would be
saved every year, could consumption be relegated to the class of extinct diseases.
From time to time statements are put forth by persons of more or less weight, suggesting
doubt as to the utility of sanatoria for persons suffering from consumption. Such doubt may
have arisen from observation of the poor, or apparently bad, results of treatment, in such institutions,
of unsuitable cases. But those who raise doubt, generally fail to notice that for multitudes
of poor sufferers, there is little or no hope unless they can be removed from the bad surroundings
of homes, where they cannot be treated to advantage, and in which they are liable to spread disease
among their families. Leaving this point, it may be well, in concluding this section of the
report, to cite the views of a few authorities as to the need, and the utility, of sanatoria. Reference
has already been made to the views of the Local Government Board for Scotland, as set out in
their circular letter, in which Local Authorities are informed that "the provisions of the
Public Health Act as to removal of cases of infectious disease to hospital, and as to the provision
of hospitals and houses of reception, are available for dealing with cases of pulmonary phthisis,
as with cases of other infectious diseases*"; provisions described as " comprehensive and elastic,"
and such as " can be adapted in practice to any type of case—incipient cases where the danger of
infection to others .... may suddenly become serious; intermediate cases where the patients, still
able to work, may, if uncontrolled, become dangerous; and advanced cases where the patients, frequently
unable to attend to themselves, may be a source of grave danger." Hence, as the Board
point out, the desirability of Local Authorities making provision for sufferers in all stages of
the disease; viz.: (inter alia) in Curative Hospitals (Sanatoria) for early cases; in "Convalescent
Colonies and Homes—Work Colonies"; and in "Hospital Wards for isolation of advanced
* The Local Government Board for England recognise Pulmonary Phthisis, in an advanced stage, and with copious
expectoration, to be an infectious disease, and have expressed the opinion that a Board of Guardians may detain in a workhouse
a chargeable person in this condition.