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49
ties, who were requested to take into consideration the desirability
,of supporting the representations of your Vestry in favour of
throwing the entire cost of the hospitals on what may be called a
Common Sanitary Fund. Several communications subsequently
passed between the Managers and your Vestry, but no approximation
of views has yet been brought about.
It may be mentioned that under the terms of the proposed
contract non-pauper patients are to be admitted into hospital upon
the " certificate" of the Medical Officer of Health. Now,
according to the Managers, non-paupers form 80 or 90 per cent, of
the cases, and these in the year ended December 31st, 1885, were
8,'253 in number. Hence it follows that the contract, if it did not
become a dead letter, would involve great delay in the removal
■of the sick; and for the medical officer, who must visit before
lie can certify, a duty almost impossible of performance in epidemic
times. It may be objected, moreover, that it is no
part of the duty of a medical officer to visit the patients and
revise the diagnosis of other medical practitioners—a practice
which would give deep offence and lead to estrangements between
those who, in the public interests, should be united in the bonds
of mutual confidence. It has been imagined that the objection to
the contract system is of a pecuniary nature, but having regard to
the high rateable value of Kensington and its comparative freedom
from infectious disease, the parish, under the arrangement favoured
by your Vestry, would have to pay an undue proportion of the cost
■of maintenance of the hospitals by contributions to the Common
Poor Fund. Under contract the charge would certainly be less.
But your Vestry have never regarded the treatment of infectious
disease as a local question, and, holding that it can be properly
undertaken by a Metropolitan authority only, have viewed payments
made through the Guardians as a premium of insurance,
just as in the analogous case of money paid for the maintenance
of the Metropolitan Fire Brigade.
How the matter hi dispute will be settled does not yet appear,
but the present difficulty lends support to my contention that the