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parishes and unions; orders for the admission of such cases to be
signed by the Medical Officers of Health. [Incidentally it may be
here mentioned that the Local Government Board, in a letter to the
Managers, dated December 6th, expressed the opinion that their
order was not necessary, but that any contract which the Managers
proposed to enter into, under the 15th Section of the Poor Law
Act, 1879, must be submitted to and approved by the Board].
By way of parenthesis it may be mentioned that the
scheme of the Managers, if adopted—and it is substantially
the scheme I proposed in March, 1877, in a communication
addressed to the Managers, having previously shadowed it forth
in 1875, in a communication addressed to the Local Government
Board—would constitute the Asylums Board the hospital authority
for dealing with cases of infectious disease in the Metropolis.
Some such scheme is necessary, for there should be but one hospital
authority; and under existing circumstances there is no other
authority than the Managers that is capable of undertaking the
work. To all practical intents, moreover, the Managers are now a
central sanitary or gztasi-sanitary authority, acting for the whole
Metropolis, and arrangements should be made for bringing them
into close and definite relations with the Local Sanitary Authorities.
It matters not whether the Poor Law Authority or the Sanitary
Authority pays for the maintenance of the sick; the money
comes out of the same pocket; but it would be a matter for
regret should Local Authorities attempt to recover from the sick
person or his representatives, any expenses incurred for maintenance
in hospital. There is, perhaps, little reason to fear that any
such attempt will be made. It would be unreasonable, for the
Sanitary Authority isolates the infected for the protection of the
healthy, and often finds it difficult enough to persuade the sick
person to go into hospital. Should the Authority in such cases try,
upon the discharge of the patient, to make him pay for an irksome
seclusion, to which probably he unwillingly consented pro bono
publico 1 Were the power to do so exercised, it would practically
neutralise any advantages to be expected from the proposed
system of contract. It is to be hoped, therefore, that any