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Committee, patients were received, not merely on the application
of medical officers of health and sanitary inspectors, but also
upon the direct application of private medical practitioners, and
without the previous order of a relieving officer. This satisfactory
state of affairs would probably have been perpetuated—for
although the practice was not formally sanctioned, it was well
known to the Managers and to the Local Government Board
—but that some of the sanitary authorities, who had profited so
largely under the new system, complained occasionally, in
terms to which objection might well be taken, of the heavy
expenditure incurred in the maintenance of the hospitals. It
was not altogether surprising, therefore, however much to be
regretted, that the disposition of the Managers in the matter
should have undergone a change, and that, with the object
of throwing a proportion of the cost of hospital maintenance
upon the general rate, they resolved, in October, 1884, to
, apply to the Local Government Board for " approval" of a
scheme to enable them to contract with the several vestries,
with a view to the reception of patients under the provisions
of the Poor Law Act, 1879. In due course this
approval was given, and ultimately a form of agreement was
submitted by the Managers to the several Vestries a id District
Boards, some of which consented to contract, whilst others,
your Vestry included, declined to do so. The terms of payment
proposed are not onerous, being a fixed charge of four guineas per
case, to include the maintenance and clothing of the patient when
in hospital, as well as removal to and from the hospital, but not
the cost of any new clothing that may be supplied on discharge,
n nr the cost of the funeral of any patient who may die in hospital.
The Managers took care tj have it understood that their
" responsibility, thus voluntarily assumed, for the reception and
treatment of non-pauper cases, will cease immediately accommodation
at their disposal shall no longer be available," and then
" the duty of provid.ng for the treatment of patients " other than
paupers, will devolve as now upon the sanitary authority of
the district where the cases may arise.