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43
The accumulated experience of years, and the expression of the views of Congresses, of Public
Health Authorities, and of experts like Koch, and others scarcely less eminent, as to the value of
sanatoria, had not sufficed to raise the question to a higher level than one of monetary consideration
; a consideration which, nevertheless, might be pleaded as an overwhelming justification for the
establishment of sanatoria, having regard to the cost of consumption to the community, through the
loss of wages (to mention no other source of loss), adverted to by the Prince of Wales.
Other cities, only less important than London—Liverpool, Birmingham, Edinburgh, Glasgow,
Dublin,—recognise the value of the open-air treatment, and have provided, or decided to provide
sanatoria. How great the need of London is may be established by a statement of the fatality of
tuberculosis in 1906. The total deaths registered were 6,908, including 6,775 from pulmonary
phthisis alone; and of these latter, no fewer than 5,583 (82-4 per cent, of the entire number) were
of persons between the ages of 20 and 60 years,* the best working period of life; the majority of
them, moreover, being of the male sex—the bread winners.
In concluding this portion of my fifth monthly report (May 28th), dealing with this question,
I asked: " Can nothing be done to stop the plague ?"
In an earlier part of the report I had stated that there was reason for thinking that the efforts
to bring about the provision of sanatoria, suspended two years previously might be renewed then,
with better prospect of success: how, I proceeded to explain.
THE SOUTHERN HOSPITAL.
When urging the allocation of the Gore Farm hospitals to sanatorium purposes, in 1902, I
referred also to the " Southern Hospital" which the Managers of the Asylums Board had decided
to erect at Carshalton, for convalescent fever and diphtheria patients. From what I knew of the
principle on which that hospital was designed, I expressed the opinion that it would be well suited for
use as a sanatorium. It was handed over to the Board by the builders in the autumn of 1906 ; and
in November a Special Committee was appointed " to consider and submit a report as to the best
use to which [it] can be'put." The report submitted 27th April, 1907, was to the effect that the
hospital was " not required for the presentthe Committee therefore discussed the question
"whether it was desirable or expedient to use the hospital for any other purpose? " In this connexion,
they said, three (but really only two) "alternatives" had been suggested. The second of these
need not detain us; it was " to make use of the hospital as an industrial home for the treatment and
training of sane epileptics and feeble-minded cases." The first " alternative" suggested was
"To make use of the buildings for the treatment of patients suffering from consumption" (the
italics are mine) " allocating a certain number of beds to each of the metropolitan parishes and
unions, in proportion to their respective populations " ; but for what does not seem a very cogent
reason the Committee did " not consider that the time [was] ripe for the Managers to come to
a definite decision on the subject; they therefore recommended a third " alternative," namely,
" to keep the hospital unoccupied for a further 12. months, and then reconsider the whole question ;"f
and they asked the Managers to adopt the following recommendation—
" That inasmuch as the accommodation already provided by the Board in their acute
and convalescent hospitals is sufficient for their present purposes, and is likely to be sufficient
for the needs of the metropolis for some time to come, the Managers are of opinion
that the Southern Hospital is not now required for fever hospital purposes."
* Between 20—40 years, 2,969 ; between 40—60 years, 2,614.
†An ineffectual effort was made, in July, to get ths question of the use of the hospital reopened by a motion to
rescind the resolution. More success attended a further effort on November 9th when the following notices of motion
were considered—
That the Board's resolution of the 27th April, 1907, deferring for twelve months further consideration of the
question of the purpose to which the Southern Hospital should be applied, be, and is hereby rescinded.
That, subject to the sanction of the Local Government Board, the Southern Hospital be opened for the
accommodation and treatment of consumptive cases in the early stages, chargeable to the Metropolitan boards of
guardians.
The first motion was carried by 38 votes to 3, the Managers being thus set tree to consider the " purpose to which this
hospital should be applied."
Consideration of the second motion was deferred until 23rd November, when an amendment to it was moved as
follows:—
" That, inasmuch as the Local Government Board, in their letter of the 22nd March, 1906, on the subject of the
proposed establishment by the Managers of sanatoria for the treatment of consumptive patients, stated definitely that
the information then before them did ' not appear to afford sufficient justification for the very heavy outlay which
would be involved in the proposal,' the Managers are not prepared to sanction the use of the Southern, or any other
Hospital, for the accommodation and treatment of patients of this class."
After a long debate the amendment was defeated on a show of hands by 28 votes to 24 and on a division by 33 to 23.
A second amendment was moved, and carried, to the effect:—
"That, in the absence of instructions from the Local Government Board in reply to the Managers' last communication
on the subject of the provision of accommodation for tuberculous patients, this Board cannot see their
way, at present, to take any useful action."
On the amendment being put as a substantive motion, a further amendment, to omit the words " at present," was carried
by 34 votes to 24, and the motion, as amended, by the omission of those words, was adopted.
The " last communication " of the Managers to the Local Government Board, mentioned in the second amendment, was
based on a report (17th February, 1906) of the General Purposes Committee (i.e., the Board, sitting in Committee) to whom the
Memorial of the London Medical Officers of Health had been referred. (Vide page 42.)