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58
Order of the Local Government Board, dated 10th February,
1875. The patient, called "pauper" in the Order (but
admission no longer pauperises), is admitted upon an order
filled up and signed by a Relieving Officer, or a Master of a
Workhouse, of the Union or Parish from which he is sent to the
Hospital; the said order being accompanied by a certificate
signed by the Medical Officer either of the Workhouse or
District, as the case may be (Article 3), or latterly, by any
other registered medical practitioner. In a valuable report
prepared by the Ambulance Committee of the Asylums Board,
for the guidance of the General Purposes Committee, which
comprises the whole Board, it is pointed out that the above
Article and others "were framed in view of arrangements
essentially different from those now in force." Reference is
made to the fact that previous to 1881, in which year the
Ambulance system of the Board was brought into working,
patients were brought to the hospitals in parish ambulances,
"and it was at the door of the hospital that their contact with
the Asylums Board commenced." Now, however, "the door
of the ambulance carriage has taken the place of the door of the
hospital," and the hospital officials have "no choice but to
receive as patients all persons brought in by the ambulances of
the Managers." The parish ambulances, moreover, have for the
most part ceased to exist. Formerly they were, in some cases
at least, available for the removal of "non-pauper" patients.
After their abolition Nuisance Authorities were wont to apply
to the Managers for the removal of their patients. "To these
applications the Managers, in the first instance, declined to
accede." In 1884, however, when small-pox was prevalent,
and upon the receipt of urgent representations from various
public authorities, the Managers, "convinced of the hopelessness
of coping with the disease by any other means, countenanced
the practice of removing cases upon the application of the
officials of Nuisance Authorities"—under circumstances set out
in my Annual Report for that year— "a step the wisdom of
which has never been challenged." The Managers are now