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for the isolation and treatment of epidemic infectious diseases in the
Metropolis does not exist, and that such provision could be best made in
a comprehensive and systematic manner by one Central Authority acting
for the whole Metropolis, not only for pauper patients, but for other classes
in need of Hospital accommodation.
"Tour Committee are also of opinion that the Metropolitan
Asylum Board should be such Central Authority, its constitution being
altered and adapted to its enlarged duties and responsibilities;
that the expenses of persons not being paupers admitted into the hospitals
at the recommendations of Yestries and District Boards under
seo. 37 of the Sanitary Act, 1866, should be defrayed out of a Metropolitan
Rate or Common Fund, and that the relief so granted to persons suffering
from infectious disease should not be deemed parish or poor relief,
and should not involve the loss of any rights possessed by the said
persons."
My opinion having been desired by the Managers, I replied in
the following terms:—
"I have much pleasure in complying with the request of the
Managers ef the Metropolitan Asylum District, for the expression of my
opinion on the Report of the 'Committee for General Purposes relative
to the provision of hospital accommodation for small pox patients not being
paupers.'
"In the first place, I fully endorse the opinion of the Committee, that
'adequate provision for the isolation and treatment of epidemic infeotious
diseases in the Metropolis does not exist.' And I coneur in their' conclusion
(a) that such provision could be best made in a comprehensive
and systematic manner by one Central Authority acting for
the whole Metropolis.'
"The cause of the present deficiency is not far to seek. The 37th
section of 'the Sanitary Act, 1866,' gave the local sanitary authorities
power to provide hospitals for the 'sick inhabitants' of their several
districts, and this power would probably have been acted upon, had not
the 'Metropolitan Poor Act, 1867,' (under whioh the Asylums of the
Managers have been established), appeared to supercede by a general
provision for the entire Metropolis the necessity for separate action by the
Yestries and District Boards.
"The Managers have nearly met the requirements of the Metropolis,
by providing hospital accommodation out of all proportion to
the wants of the pauper class—thus doing the work which legally
devolved on the sanitary authorities: and they appear willing, if called
on, to extend and to complete the task.
"The question now is, shall they do so; or shall the duty be discharged
by those to whom it rightfully belongs?
"For my own part I should be content to see the Managers go on as
heretofore, providing accommodation for all comers, but with authority
to receive payment for such non-pauper oases as the Yestries and District
Boards may send under the provisions of the 37th seotion of the Sanitary
Act, 1866—on two conditions; viz.:—(1) That such payment should be
made out of a Metropolitan rate or common fund, and (2) That relief in
the hospitals should be placed on the same footing as public vaccination,
so as not to entail any loss of social or political status on its recipients, it
being for the interest of the community that infectious diseases should
be dealt with at the cost of the community, so far as regards hospital accommodation.
This plan has the merit of simplicity—involves the fewest
changes, and would entail little or no delay in execution.
"But if these conditions are inadmissible, (and seeing that 90 per
cent, of the sick in the Asylums are 'not paupers,') I should prefer a