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38
THE METROPOLITAN ASYLUMS BOARD.
Under the provisions of the (now repealed) Sanitary Act, 1866 (sec. 37), the local sanitary
authority was endowed with power to provide, for the use of the inhabitants within its 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 a limited period, in time of emergency,
e.g., when small-pox was epidemic, this power was not exercised, despite the pressure brought
to bear to induce sanitary authorities to erect local hospitals. The late Vestry led the opposition to
the establishment of such hospitals, with little support at first, but ultimately with complete success ;
and no one now doubts that the policy of that body, adopted in 1877, was wise, and fruitful in benefit
to the entire Metropolis. In 1867, the Metropolitan Poor Act brought the Asylums Board into
existence, and this body soon set to work to provide infectious disease hospitals for the " sick poor,"
i.e., paupers. As a matter of fact, however, and despite the disabilities attaching in theory to the
use of these hospitals, they were largely used from the beginning by non-paupers ; and in course
of time legislation gradually secured to the inhabitants of the Metropolis all the advantages desired
and contended for by the late Vestry. The hospitals are now free to all, no disability of any kind
attaching to the use of them by any person whatsoever. The Managers, as the central authority,
have fulfilled their duties admirably, and have created for London a hospital system unequalled
elsewhere, and which, it is perhaps not too much to say, is the admiration of foreign nations.
Be this as it may, the Managers fulfil the duties originally devolving upon 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 powers as to leave almost nothing
to be desired.
Report of the Statistical Committee for 1899.—Prior to 1898 the work of the Asylums
Board was summarized annually in three reports, prepared respectively by the Chairman of the
Board, the Ambulance Committee, and the Statistical Committee. The three reports overlapped in
many directions. For 1899 a single report issued by the Statistical Committee covers the entire
ground. The report is comprised in two volumes ; the second volume, treating of matters relating
to the work of the Managers as the Hospital and Ambulance Authority for London, having
naturally the greater interest for sanitary authorities. From this report the following statement
of facts in regard to 1899 is summarized: the report for 1900 had not been published when the
present report went to press.
Notification Statistics show that 42,285 cases of infectious disease were reported in
London during the year, an increase of 4,969 upon the total in 1898. Of these cases,
36,388 (increase 4,567) were legally admissible to the hospitals; the remainder, mainly cases
of erysipelas, included 326 cases of puerperal fever. Of the admissible cases, 24,732 (increase
4,243) were admitted, the proportion being 68.08 per cent., as against 65.5 per cent. in the
preceding year. In 1890, the first complete year in which compulsory notification was in
force, the proportion of admissions to admissible cases was only 33.59 per cent., or less than
one-half of the proportion attained in 1899. A table (" A," at pp. 13-14) shows the number
of notifications and deaths from admissible diseases; the ratio of such notifications and deaths
to the population; the number of notifications of other notifiable diseases, and the grand
total of notifications, in 1899. The increase in the ratio of diphtheria to scarlet fever, which
has been a marked feature for some years past, again shows further progress, particularly
in the eastern and south-eastern districts. In seven districts the number of diphtheria
notifications actually exceeded those of scarlet fever, viz.:—Mile End, St. Saviour, St.
George (Southwark), Newington, Bermondsey, Lambeth, and Camberwell.
Charts and Spot Maps.—The course throughout the year of scarlet fever, diphtheria,
and enteric fever, respectively, is traced in charts; each showing, week by week, (a) the
notifications of the disease to which it relates, (b) the admissions, and (c) the number of
patients under treatment. Great variations are shown from week to week in the percentages
of cases admitted to hospital—ranging from 63.05 to 87.40 in the case of scarlet fever;
from 56.91 to 83.55 in the case of diphtheria, and from 20.63 to 75.00 in the case of enteric
fever. Naturally, the proportion which the hospital admissions bear to the total number
of cases is of great importance to the Managers in considering the question of the amount
of accommodation which should be provided to meet the wants of the metropolis. In this
connection it may be stated that since 1890 the proportion of admissions to notifications has
risen as follows: —Of scarlet fever cases from 42.82 to 74.34 per cent.; of diphtheria cases,
from 17.87 to 69.69, and of enteric fever cases, from 22.49 to 40.78. Enteric fever was
more prevalent in 1899 than in any previous year since the introduction of compulsory
notification. The course of scarlet fever, diphtheria, and enteric fever, month by month,
during each year from 1890 to 1899, traced in chart form, brings out the fact that, notwithstanding
that the Managers have more than doubled their accommodation for fever
cases during the past few years, it may still become necessary to make further provision,
as the present accommodation would prove inadequate should scarlet fever and diphtheria
again become as prevalent as they were in the year 1893, when the Board's hospital accommodation
was quite inadequate, only 39.68 and 24.52 per cent. of notified cases of the two
diseases, respectively, having been admitted. Spotted maps show the distribution of the
principal fevers throughout the metropolis; and tables exhibit the age and sex of cases
notified as scarlet fever, diphtheria, and enteric fever, respectively, during the year. The
two former diseases are most prevalent amongst children, over two-thirds of the cases being
under ten years of age; but whereas scarlet fever is most prevalent amongst children from
five to ten years of age, diphtheria is most so amongst those under five years.
Ambulance Work.—During the year, 24,945 fever, diphtheria, and small-pox patients
were conveyed to the various hospitals of the Managers, an increase of 3,986 upon the
total in 1898, there having been a corresponding increase in the number of transfers to the