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provision of local or district hospitals, I expressed views (which in 1882 were endorsed by the
Royal Commission in their report on infectious disease hospitals) in favour of—
(1) A single hospital authority for London; the Asylums Board as a matter of
venience;
(2) Free admittance to the hospital for all classes of the people;
(3) Depauperisation of medical relief in the hospitals; and
(4) Maintenance of the hospitals out of the Common Poor Fund created by the
politan Poor Act, 1807.*
The opposition to local or district hospitals was successful, and the views above set out,
having received the approval of the Vestry, were made the basis of efforts which never ceased
until every principle contended for in respect to hospital accommodation for the infectious
sick had, in successive Acts, received the sanction of Parliament. To.day, as the result of the
labours of those years, the hospitals are open to all without charge, admission being obtainable
upon the application of any person whatsoever, the only condition being the production of a
medical certificate of disease: no disability of any kind attaches to the use of the hospitals,
diphtheria, moreover, being admissible, largely as the result of the vestry's efforts in 1889.
The Vestry may well look back with satisfaction to the labours of the years 1877.1891, which
brought such a rich harvest of benefit to the inhabitants of London, and indirectly to the people
of England generally; by legislation promoted, largely at their instance, by the Local Government
Board, with the approval of the Asylums Board and all sanitary authorities. The old
prejudice against the hospitals has ceased; little difficulty is now experienced in getting the
sick, or the friends of the sick, to accept the means of isolation; and accommodation which, prior
to 1887, was far in excess of the demand, although the beds for fever did not then exceed 1,400,
is now scarcely adequate, although nearly quadrupled. As regards small.pox, the accommodation,
1,500 beds, though far below the recommendation of the Royal Commission in 1882 (viz.,
2,700 beds), is greatly in excess of the demand, as the result of the removal of cases out of
London, a system commenced in 1881, and perfected in 1885 ; since when all cases of the disease
have been treated at the hospital ships at Long Reach, on the River Thames, or at the adjacent
convalescent hospital at Gore Farm.
Notification of Infectious Disease.—The small.pox epidemic of 1870.72, which in 1871
proved fatal to 8,000 persons in London alone, convinced me of the necessity for compulsory
notification of infectious disease, which was advocated in the annual report for that year.
Meantime, efforts to procure voluntary notification were set on foot; an arrangement was made
with the registrars for a daily return of deaths from small.pox, scarlet fever, diphtheria, and
"fever"; and an appeal was made to the guardians, medical men, the School Board, the police
and postal authorities, etc., which elicited a large amount of information of infectious sickness.
The value of the information thus obtained was enhanced by reason of the facilities for isolation
then recently provided by the Asylums Board. In 1883 I was enabled to show, by a
comparison of the deaths in 12 years (1859.1870), before hospitals had been provided, or any
attempt to obtain voluntary notification of infectious sickness had been made, with the deaths
in 12 years (1871.1882), after these helps had been secured, a large reduction in the number of
deaths from small.pox, scarlet fever, and "fever"—about 120 per annum, after correction for
increase of population. In 1876 the first Act providing for compulsory notification was obtained
by Huddersfield, and in successive years thereafter numerous other towns secured similar
powers. In 1880 I brought the subject to the attention of the Vestry, with the result that
steps were forthwith taken to unite the sanitary authorities in an effort to obtain notification
powers. The Vestry convened a conference, which was held at the Town Hall in March, 1881,
and was of a very representative character. The way to a successful issue had been paved by
sending to each member of every sanitary authority in London a Memorandum on the subject
which I had prepared, together with a copy of resolutions which the Vestry had approved as
suitable to be proposed on the occasion. The conference, largely attended by delegates and
medical officers of health, adopted the several resolutions,† and recommended a deputation to
the Local Government Board, to request that effect might be given to them by legislation. The
sanitarv authorities on the occasion of the deputation, in May, 1881, were supported by the
British Medical Association, the Society of Medical Officers of Health, and other influential
bodies. Small.pox was raging at the time; the hospitals were full to overflowing; hundreds
* I had already in 1875 suggested to the Local Government Board that the certificate of any registered medical
practitioner should be accepted as evidence of the nature of the infectious disease. In 1887 the Board issued an Order
authorising this procedure, which hail then been for several years in practice with the approval of the Asylums Board.
† The resolutions were in favour of (1) compulsory notification. (2) compulsory removal of the sick to hospital, when
necessary. (3) free treatment of the sick in hospital, (4) depauperisation of medical relief in hospital, and (5) maintenance
of the hospitals to be a charge on the Metropolitan Common Poor Fund. All of these objects have long since been secured.