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69
THE METROPOLITAN ASYLUMS BOARD.
Under the provisions of the (now repealed) Sanitary Act, 1866, the local sanitary authority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 1906 is a document of much interest to Public
Health and Poor Law Authorities—to all ratepayeis indeed—by reason of the importance
of the duties devolving upon the Managers, and the magnitude of their expenditure, which in the
financial year ended 29th September, totalled £1,167,605 (equal to a rate of 6⅛d. in the
£): viz., £1,055,300 on general account, and £112,305 on loan acount. Of the expenditure
on general account, 63 per cent. was in respect of the infectious hospitals and the ambulance
services. In the 39 years of the Board's existence £3,533,717 has been borrowed* for the purpose
of hospital construction (17 hospitals), including £225,150 for the Western Hospital to which
Kensington patients are removed; for the Land Ambulance Stations £90,950, and for the
river service £108,496. The number of persons maintained on the last day of the year was
18,065; viz., permanent staff (excluding Head Office and Stores) 5,117, and inmates 12,948.
The Institutions administered by the Board are 51 in number, including one in course of
construction; amongst them being 16 hospitals for infectious diseases; 3 Seaside Homes for
children; a land ambulance service (8 stations), and a river ambulance service (3 wharves and
5 steamers). The Board's properties comprise an area upwards of 1,500 acres.
The report is supplemented by reports of committees by which the work of the several
departments is carried out. From these reports we learn that the average daily number
of patients (all diseases) under treatment, was 4,096, against 3,396 in 1905; an increase
approximating 20 per cent. The subjoined particulars are given of Infectious Diseases:—
Notifications. Admissions Death-rates,
to hospitals. 1906.
(i.) Scarlet fever 20,329 17,983 2.94
(ii.) Diphtheria 7,929 5,218 8.77
(iii.) Enteric fever 1,600 698 16.02
(iv.) Typhus fever 7 4 —
(v.) Smallpox 31 29 —
The Statistical Committee state that out of 35,812 notified cases of infectious disease,
30,023 were legally admissible to the Board's hospitals, and £25,213 (84 per cent.) were
actually admitted†: 26,044 patients were treated at the fever hospitals (2,150 in
excess of the numbers in 1905, and the highest on record); 1,237 persons died; 4,930 were
remaining at the end of the year. The maximum number of patients (5,498) was recorded
on November 20th; the minimum (3,108) on 28th April.
Up to and including the year 1905, diphtheria is stated to have been declining since 1899;
last year, however, it was more prevalent than in any of the three preceding years. ‡ Scarlet-fever
also increased in prevalence, and more cases were notified in 1906 than in any year since
1897. Enteric fever notifications were slightly more numerous than in 1905, but in 1905
they were lower than in any year since notification became compulsory, in 1889.
* The Board's aggregate borrowings were £5,606,799, of which £2,190,801 has been repaid: their net indebtedness at
the end of the financial year, on loan account, being £3,415,998.
† The Kensington notifications are given as 848, equal to a rate of 3.8 per 1,000 persons living—the rate for London, as a
whole, being 6.4 per 1,000. The Kensington scarlet-fever notifications were 470, the admissions to hospitals 403; diphtheria
notifications 178, admissions 144; enteric-fever notifications 39, admissions 27. Total notifications of these diseases 687,
admissions 574=83.6 per cent. The London rate of admissions was 85 per cent.; the percentages being, of scarlet-fever 88.5,
of diphtheria 79.7, and of enteric-fever 55.1.
‡ Cases of membranous croup are now admitted to the hospitals though not stated to be of a diphtheritic nature.