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London County Council.
ANNUAL REPORT OF THE COUNCIL, 1934.
VOL. IV (PART I)—PUBLIC HEALTH (General and Special Hospitals).
REPORT ON THE HOSPITALS AND GENERAL MEDICAL SERVICES
UNDER THE CONTROL OF THE HOSPITALS AND MEDICAL SERVICES
COMMITTEE.
By Sir Frederick Menzies, K.B.E., M.D., LL.D., F.R.C.P., F.R.S.E., County
Medical Officer of Health and School Medical Officer.
Introduction.
The progress of the hospital service during His Majesty's reign.
During the first twenty years of His Majesty's reign the public hospitals of
London were administered by the poor-law authorities, but, as the Local Government
Act, 1929, transferred the functions of these authorities to the Council, by
whom the hospitals have been administered since 1st April, 1930, it is appropriate
that a reference should be made in this report, which will appear in the Jubilee year,
to the improvements effected and the extension of the facilities provided in the
hospitals since His Majesty ascended the throne.
The passing of the Poor Law Act of 1867 enabled separate accommodation,
to be provided for the sick poor in workhouse infirmaries. Since that year there
lias been a gradual development of the accommodation provided for the sick poor,
and an increasing tendency to make such provision on hospital lines. In the early
years of the present century gradual progress was made in improving the poor-law
infirmaries. The improvements were, of course, more marked in certain hospitals
than in others, and this was particularly evident in London, where no fewer than
25 boards of guardians were responsible for the administration of the hospitals, and
considerable diversity was inevitable. The Local Government Act of 1929, however,
by placing the poor-law infirmaries under the control of the County Council,
furnished an opportunity in London of unifying the hospital service and bringing
the different establishments up to a uniform standard of efficiency. The Act also
made possible the final stage in the evolution of the modern municipal hospital
from the old poor-law infirmary by conferring upon local government authorities
power to acquire or "appropriate" hospitals for the reception of the sick, unfettered
by the Poor Law. The Council quickly took advantage of the opportunity, and on
1st April, 1931, "appropriated" most of the general hospitals which had been
transferred to its control a year earlier. The remainder have since been appropriated.
These hospitals are now administered under the Public Health Acts as municipal
hospitals, and the proportion of patients admitted under a relieving officer's order,
formerly the great majority, is steadily decreasing, until in 1934 it was less than
18 per cent, of the total number of admissions.
The magnitude of the task confronting the Council on 1st April, 1930, may
be illustrated by the fact that on that date it assumed responsibility for no fewer
than 76 general and special hospitals and institutions containing more than 42,000
beds and a staff of nearly 20,000. Buildings which were out of date, or on other
grounds unsuitable or inadequate for their purpose, required to be adapted or
demolished and rebuilt; existing equipment needed to be overhauled or replaced,
and much new apparatus was required ; the staff, of many grades and working
on differing conditions of service, had to be assimilated into one service.
During the period which has elapsed since 1st April, 1930, considerable progress
has been made in dealing with these problems. New hospital blocks have been
built and reconditioning works carried out, and a continuing programme of
structural alterations is gradually bringing the hospitals up to a high standard of
modern efficiency. Improved facilities have also been provided to enable advantage
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