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15
severance of the connection between Poor Law Administration and the
hospital treatment of infeotious diseases. This might be effected by the
constitution of a 'Central Authority' (on the plan of the Metropolitan
Board of Works), to be elected by the Vestries and District Boards of
Works, and having power to provide accommodation for all persons
'whose isolation in hospitals is necessary for preventing the spread of
disease.'
"On grounds of public policy I would transfer the execution of the
vaccination acts in the Metropolis to the same authority.
"What 'powers under the Sanitary Acts' beyond those contained in
the 37th section of the Sanitary Act, 1866, the proposed 'Central
Authority' would require I do not know; but I venture to believe that
the provision of hospital accommodation would meet the necessities of
the case, leaving the local administration of the Sanitary Acts un.
touched.
"This 'public hospital' system would probably entail some additional
expense on the ratepayers, but none commensurate with the benefits
that would accrue from the safe treatment of infectious diseases which is
the object in view; and whatever the increase in cost it would be borne in
the same spirit as the charge rendered necessary by the establishment of
a fire brigade; for it would be regarded as a premium paid for insurance
against a risk as much more serious than fire, as health and life are more
precious than property.
"Special provision should be made at each hospital for persons who
are able and willing to pay for their maintenance, if room for such cases
cannot be found, or made, at the London Small Pox Hospital at Highgate,
and at the London Fever Hospital.
"But the poor ratepayer, the dependent classes and those sick persona
whose isolation is enforced or solicited for the good of the community,
viz., with a view to prevent the spread of disease, should have
free admission.
"It is, perhaps, hardly necessary to point out that these are the
classes for whom our voluntary general hospitals (where infectious diseases
are not admissible) have been established and are supported.
Nominally excluded from the Asylums they yet form the
great bulk of their inmates through the wise disregard by the Guardians
of the strict letter of the law. Sanitary Officials have had difficulty enough
in persuading many such persons to go into the hospitals, and the refusal
of others has frequently led to an extension of disease. What proportions
the present epidemic would have attained had the generality of such cases
been excluded can be better imagined than described. The exaction of
payment from the sufferers will be fatal to any scheme which aims at complete
isolation in suitable cases.
"It would be easy to enlarge on the subject, to which I have long
given earnest attention, and whieh I have dealt with, in reports addressed
to my Vestry, the latest of which I beg to submit to the Managers in
further exposition of my views.''
In the report referred to in the last paragraph of my letter to the
Managers (No. 15, 1876, read January 10,1877), I had dealt exhaustively
with the letter of the Local Government Board (Jan. 2,
1877), in which your Yestry were urged to provide hospital
accommodation for the non-pauper sick under the 37th section of
the Sanitary Act, 1866; and after pointing out the several modes
in which this object as a means to meet a temporary emergency
could be met, I concluded by stating my opinion that
"The wisest course with respect to the future, for all time, would be