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with the non-pauper sick is still a burning question. It is a question
which should be settled, no doubt, and on some definite
principle, forthwith, and it may be expected in quieter times to
receive that attention from the Government and the Legislature to
which its importance gives it a claim.
The only suggestion of a public nature (so far as I know), that
has been offered since the date of my last report, proceeded from
the Board of Works for the Limehouse District who, in a Memorial
addressed to the Metropolitan Asylum District Board—after
setting out the "almost insurmountable obstacles" to provision
of hospital accommodation being made by the Sanitary Authorities
(under section 37 of the Sanitary Act, 1866), stated their
opinion that "the most practicable way of overcoming the difficulty
in providing Hospital accommodation for Non-Pauper cases
in each district would be for the Metropolitan Asylum District
Board, who already have the necessary staff and appliances, to make
arrangements, upon the request of the Sanitary Authorities, to receive
any person, not in receipt of parish relief, whom the Sanitary
Authorities might require to have removed to Hospital, and that
the Asylum Board should provide a separate Department for
the accommodation of such cases, so that they could be kept
distinct from Pauper Patients."* The Limehouse Board were further
of opinion " that the Sanitary Authorities should pay for
the accommodation provided for Non-Pauper cases by an annual
payment, whether such accommodation is required or not, or by a
fixed sum for each patient sent."
The Asylum Board having referred this Memorial to the
Committee for General Purposes, the Committee in their report
dated 18th March, 1878, recounted the steps taken in 1877 by
the Managers to meet the difficulty, and the conclusions to which
they had unanimously arrived, and which were set out in
my Annual Report for 1876, (page 13), and they referred to the
action taken by the Managers in suggesting to the Local
Government Board that clauses 56 and 64 of the " Public Health
(Metropolis) Bill, 1877," should be amended by making it
"Incumbent upon all Local" (i.e., Sanitary) "Authorities either
to provide the requisite Hospital accommodation for their Districts,
or failing their so doing, within a specified time, to contract
with the Managers of the Metropolitan Asylum District
for the reception into their Hospitals of persons other than
paupers who may be suffering from infectious diseases.
"The withdrawal of the Bill subsequent to its second reading,
however, left this all important question in abeyance.
"It will thus be seen," the Committee continue, " that the
I. may be remarked that paupers constitute less than ten per cent, of the sick.