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37
ation of the question; lialf-a-dozen return irrelevant or indefinite
replies; while seven express, in more or less general terms, their
readiness to enter into arrangements with the Managers.
A copy of these replies was forwarded to the Local Government
Board for their consideration, with what result remains to be seen : but
certainly the replies themselves do not appear to advance the subject
very much, nor do they quite realize the sanguine expectations of the
Board. Possibly the vague character of the replies may in some
measure be accounted for by the very general nature of the questions
submitted by the Managers. No Nuisance Authority could answer
the second question—as to the number of beds required— with any
precision until "the needful line of distinction has been drawn between
pauper and non-pauper patients," and the question must perforce
remain open until such distinction shall have been drawn.
It is well known that one part of the Metropolis may be comparatively
free from an infectious disease prevalent in other parts: and
that an epidemic is apt to travel from place to place, so that before it
is at an end every part of the Metropolis may have been visited in
turn. Hence the Vestries not unreasonably object to engage and pay
for a fixed number of beds, for which, during considerable periods, they
might have no occasion. The only perfectly satisfactory mode of
dealing with the question would be, as I have often before stated, to
spread the burden of infectious disease over the whole Metropolis on a
"common fund," and to give free admission to all sick persons desirous
of being isolated in the hospitals, or who may be sent to them for
isolation (excepting only such persons as may be able to pay for medical
treatment, &c., and these should go to the London Fever Hospital or
the London Small-pox Hospital). Until this is done the most rational
way of settling the matter under the provisions of the new Act, would
be for the Managers to fix a tariff of charges per case per diem,
calculated on the known cost for maintenance and administration, and
let each Nuisance Authority pay for its own sick on the approved
scale.
"DISQUALIFICATION BY MEDICAL BELIEF."
In my last Annual Beport I referred to an attempt made by certain
members of Parliament, irrespective of party, to deal, in what I
believe to be the only satisfactory manner of dealing, with the subject
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