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37
is so dangerous. I contended so far back as 1875, that the
certificate of any duly qualified medical man should be
accepted as evidence of the nature of a dangerous infectious
disease, (e.g., small-pox, scarlet fever, enteric fever, &c.), and
I am of opinion that the Medical Officer of Health, equally
with the Relieving Officer, should be authorised to sign the
order for the admittance of a patient.* To all practical
intents and purposes the Managers are now a sanitary or
quasi-sanitary authority, acting for the whole Metropolis,
and arrangements should be concerted for bringing them
into close and definite relations with the local sanitary
authorities, the vestries and district boards, with a view of
facilitating the admittance of the patients, who, as already
explained, will be transferred to the hospitals in the Managers'
own ambulances. And this without the necessity of
contracts between the Managers and Sanitary Authorities,
(under the Poor Law Act, 1879), for the maintenance and
treatment of non-paupers; for the hospitals, although conducted
by a Poor Law Authority, are no longer pauper
establishments. Certain expenses incurred by the Managers
in the treatment of the sick, viz., for maintenance, clothing,
&c., are at present repayable by the Guardians of the
parish or union from which the patients are admitted, and
it can matter nothing whether such repayments are made
by the Guardians, as Poor Law Authority, or by the Vestry
as Sanitary Authority. So long, however, as the elective
Managers are chosen by the Guardians exclusively, it will
probably be found convenient to continue the existing
arrangements, but I need hardly say that I concur in the
recommendation of the Hospitals Commission, which indeed
merely endorsed my views, long ago sanctioned by your
Vestry, that the sanitary authorities should be represented
at the Board. I am strongly of opinion, however, that it will
* Shortly after this portion of the report was in type, more than I had ever
ventured to ask, was conceded by (he new arrangements of the Asylums Board,
as set out in the " Regulations for the removal of cases of small-pox and fever
by the land and river ambulances." The subject is referred to again further on.