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39
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 might 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
and the London Fever Hospital.
But all others— the poor ratepayer, the dependent classes and those
sick persons 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
cases 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 recent 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*
*" On the admission of patients "to the hospitals, I cannot refrain from quoting
some observations by Dr. COLLIE, Medical Superintendent of Homerton Fever
Hospital, in the paper on Small-pox hospitals already referred to. He says that,
for the admission of patients "there ought to be no formality, and no sort or
kind of difficulty From a public health point of view admission ought to
be entirely free of any formalities whatever" (Dr. Collie is alluding to the forms
necessary under existing Poor-Law machinery, and the delays to which they give
rise). "Presuming that there would be a resident medical officer at the hospital,
certificates might be entirely dispensed with. Let it be well understood that any
person having the disease will be admitted on presentation. Our object, as public
health authorities, is to induce people to go into hospital—that of the Poor-Law
authority is to keep people out; and, therefore, admission to Poor-Law hospitals
is attended with much formality, which may be necessary enough from a Poor-Law
point of view, but which is fatal to the prompt isolation of infectious disease, and,
therefore, to efficient sanitary administration."
The views here expressed may, perhaps, be thought, a little too extreme,
but if so they err in the right direction. The only remedy for the present dead-lock
is to separate the treatment of infectious disease from all connexion with the
Poor-Law system and pauperism.