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provides for the "recovery of cost of maintenance of patient in
hospital;" any expenses incurred by a local authority in
maintaining the non-pauper patient in the hospital "shall
be deemed to be a debt due from such patient to the local
authority, and may be recovered from him at any time within six
months after his discharge from such hospital, &c., or from his
estate in the event of his dying in such hospital, &c."
No doubt cases will from time to time be admitted into the
hospitals to which this section will be applicable, and there will be
other cases where the patient will be willing and desirous to pay
all the expenses incurred on his behalf (though in my judgment the
London Small Pox Hospital at Highgate, and the London Fever
Hospital at Islington are the more suitable establishments for such
cases); but I am convinced that the object we all have at heart,
viz., the isolation in a hospital of every suitable case needing to be
isolated, will be utterly frustrated if any attempt is made to make
the hospitals generally self-supporting. I need not enter into the
question here, however, as I have already dealt with it above,
and in a special report on the Bill which I addressed to your
Yestry on the 27th June. I am convinced, moreover, that the
compulsory exaction of payment will fall through in practice; for
the mere threat of such an exaction would have the effect of rendering
the hospitals comparatively useless. The non-pauper sick
would not go to them; the pauper sick would not fill a tenth of
the beds. Moreover at the present time, though the Guardians
have ample powers to recover just as the 'local authority' would
have under the proposed Bill, they have realized the absolute futility
of the endeavour to do so in all but the rarest cases; and I contend,
that in generally abstaining from pressing their legal claims,
they have exercised an admirable discretion, and justly earned the
thanks of the community by which the hospitals are maintained
for the public good. I object to sham legislation and to the creation
of powers not intended to be used. I object to the permissive
" may " in the administration of sanitary law. Either a thing
should be done or it should not. If it is right make it compulsory.
If it is wrong or indifferent leave it alone. Let us face this question
boldly and firmly, and act up to the views that are now held
by nearly all authorities, by dealing with infectious diseases as we
do with vaccination. Stamp them out at the public cost, charge
the expense to a Metropolitan rate. Separate the relief in hospitals
from all taint of pauperism; but let us at the same time
press for additional powers to enable us to collect into the public
rate-supported hospital any sick person whose retention " at
home " is a danger to the occupants of the same house and to the
locality. Let us, moreover, take whatever other steps may be
necessary to deal effectively with infectious disease, especially by
providing disinfecting chambers, mortuaries, &c.