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51
It will be remembered that at the deputation to the Metropolitan Asylums Board, in 1905,
the need for sanatoria, and for constituting the Managers the Sanatorium Authority for London,
was affirmed by representatives of The National Association for the Prevention of Consumption,
The Royal Institute of Public Health, The Royal Sanitary Institute, The National Health Society,
The Metropolitan Hospital Sunday Fund, The Metropolitan Hospital Saturday Fund, and (the
Metropolitan Branch of) The Society of Medical Officers of Health. With such testimony to
the need for sanatorium treatment and hospital isolation, it is disheartening indeed, to see the
movement practically in abeyance. Progress would seem to be well nigh hopeless until the Local
Government Board shall have become convinced—as it is to be hoped they will be, as a result of
the report of their medical inspector, above-mentioned—that it would be a wise course to carry
out the recommendation of the Deputation which has the approval of the majority of the local
authorities, to constitute the Asylums Board as the Sanatorium Authority. The subject is
referred to in the Asylums Board annual report for 1905; but, hitherto, both the Managers and
the Local Government Board assume the question to be one of expense—overlooking the probability
that a moderate outlay now, would save a far greater in the future: the immediate outlay,
moreover, would probably not be so great as anticipated, it being only too likely that it will take
a long time to persuade poor people, in any large number, to enter sanatoria in the early and
curative stage of the disease, and whilst they are able to work for their families—though to
do so entails inevitable shortening of life.
In order to give effect to the prayer of the Medical Officers' Memorial, no new buildings
would be necessary for there are many hundreds of empty and available beds in the Board's
hospitals. The Chairman of the Hospitals Committee stated, last year, that the normal
accommodation in the acute hospitals, was 4,731 beds, and the maximum number of patients under
treatment (in 1905) 3,615 ; whilst as regards the convalescent hospitals, which are' deemed the more
suitable for sanatorium purposes, the number of beds was 2,588, and the maximum number of
patients 1,562. But the case is really far stronger than thus represented; seeing that the Managers
have 10,000 beds at their disposal, and about half of them empty! All that was asked by the
deputation to the Managers was that the Gore Farm Hospitals should be utilised for the treatment
of pulmonary phthisis, which kills more people, and those mostly adults, than all the
other infectious diseases, for which the Managers have made such ample, not to say excessive,
provision, under the authority of the Local Government Board.
Dispensaries.—More than one reference has been made to the need for dispensaries as an
auxiliary means for dealing effectively with the numerous class of out-patient sufferers from
pulmonary phthisis. The London International Congress (1901) affirmed the need for " the provision
of anti-tubercular dispensaries, as the best means of checking tubercular disease among the
industrial and indigent classes," for whom sanatorium provision could not be made; and at the Paris
Congress (1905) one of the resolutions adopted, affirmed that " the principle of sanatoria and
dispensaries must be recognized." The Local Government Board for Scotland, in their aforementioned
circular letter to local authorities, advocate the establishment of "dispensaries for pulmonary phthisis."
On the continent these institutions, we are told, " have been of immense value (incidentally) in the
discovery of insanitary conditions," the baleful influence of which, in favouring the onset and the
spread of consumption, needs no insistence. Public Health Authorities in England,generally,
have power to provide hospitals, and supply medicines, but not to establish dispensaries. Such
power would, however, appear to be possessed by Metropolitan Poor Law Authorities (30 Vic. c. 6
sec. 38). In Germany, more stress is laid on provision of isolation—the chief weapon being the
working-class sanatorium—whilst in France the anti-consumption dispensary seems to hold the chief
place; the object in the one class of institution being "mainly curative; that of the other
prophylactic," the two classes of institutions mutually completing one another. So says Professor
McWeeney,in his report to the Local Government Board for Ireland on the Paris Congress ; the
conclusion at which he arrives being that a " judicious combination of sanatoriums and dispensaries
would appear to be the most rational indication for a country, which, like Ireland, is, as yet
on the threshold of organised effort against tuberculosis." This gentleman gives a description of
the working-class sanatorium system as it exists in Germany, and also of the Continental type of
Dispensary, which "has hitherto been chiefly confined to France and Belgium ;" the object of the
the latter being " to get into contact with the poor who are suffering from tuberculosis,
and to advise them how to stay the progress of the disease in themselves, and also how to avoid
infecting those who live with them." The information supplied should prove useful to health
authorities in this country, where the system described is, practically, non-existent. As regards
London, it is to be hoped that the whole question of provision for treatment of poor consumptives
may, ere long, be taken in hand by some central authority, which, preferably, perhaps, might be the
County Council; it being desirable that no social or political disqualification should result from the
relief given to sufferers, whether admitted to sanatoria or treated at dispensaries. The amount of