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to ask the Metropolitan Asylums Board to go on providing whatever hospital
accommodation may be required for all classes, as they did, to the
extent of 2,000 beds, in the last epidemic, when, with legitimate satisfaction,
they were able to boast they had not turned a sick case from the doors.
It may be true, "I added," that, by the strict letter of the law the Managers
were appointed to provide for the pauper class only, described,
however, in the preamble of the Metropolitan Poor Act, 1867, as the 'sick
poor,' and in the body of the Act as persons 'chargeable to unions and
parishes.' The object of the Act, however, it may be fairly believed, was
as much preventive or sanitary, as medical or curative. There is good
reason for believing that the Managers took this view of the case at the
outset, and that they contemplated the provision of hospital accommodation
on a much larger scale than has been done, judging from the space
they procured for the purpose in different parts of the Metropolis. These
sites are adequate for sick persons in all classes of the community, 'whose
isolation in hospitals is necessary for preventing the spread of infectious
diseases.' Practically, moreover, I believe I am correct in stating that a
large proportion, if not the majority, of cases treated in union hospitals
from the beginning have been persons 'not destitute,' not 'paupers,' not
'in need of poor relief,' excepting as the result of sickness—the Guardians
throughout London having with a wise discretion sent, and the Managers
admitted, all comers. Let it be remembered, moreover, that if expense is
in question, Guardians and Managers alike can compel those who are able
to do so to pay for their own maintenance. Separate hospitals, or special
wards in the same hospital might be set apart for those who can pay, and
indeed, classification of persons is in any case necessary. But the question
of isolation of cases is of more importance to the community than the
question of cost; and whether sanitary authorities or the Asylums Managers
provide the accommodation, the same ratepayers will have to find
the money. The work can be done more cheaply, more speedily, and more
efficiently by one Central Board, than by numerous local sanitary authorities.
The hospitals once built, moreover, and a skeleton staff of doctors,
nurses, and other officers provided, we should be prepared for any epidemic,
and should be spared the periodical recurrence of panics. On the
other hand, if vestries and district boards provide local hospitals, not only
will the first outlay be great, but each will require a staff of officers, got
together with much expense, and with difficulty, only to be scattered at
the close of the epidemic; and, possibly after all, the hospitals will not be
wanted, unless the beds in the Poor Law Hospitals should remain untenanted!
It may be said, however, that it is not right to 'pauperise'
people by sending them to' rate supported hospitals but why need they
be pauperised, even supposing they are not able to maintain themselves?
It is the fact that we often succeed in effecting the removal of sick persons
by the most earnest entreaties addressed to parents, and by appeals
to a sense of public duty. The oases are sent to hospital for the benefit of
the community, as much as (or, rather, a great deal more than) for the
benefit of the individual, though I would be the last to underrate the benefits
of hospital treatment of infectious diseases. Why, then, should not the
precedent of vaccination legislation be followed when dealing with the
disease which it is the object and, in the vast majority of cases, the effect
of vaccination to prevent? Any gentleman who hears me may go and be
re-vaccinated at the present moment, and within a few doors of this Hall,
at the public cost, and out of the poor's rate, without being pauperised—
without losing his privileges as an elector. Why? In order to lessen the
risk to the community of his catching small-pox, which is justly regarded
as a public danger. Is it reasonable, then, to pauperise an artizan, when
he is so unfortunate as to suffer in his household, or person, from the disease
we are so anxious to prevont, because he, unwillingly indeed, but