PUBLIC HEALTH—THE LOCAL GOVERNMENT BOARD.—OBSERVATIONS. (Hansard, 1 August 1881)

DR. CAMERON

, in rising to call attention to the power possessed by the Local Government Board for the prevention and control of formidable epidemic diseases, and the manner in which those powers have of late been exercised, said he would not have ventured to call the attention of the House to this subject, had it not been for the very critical and dangerous position in which the Government were at present placed. At the last meeting of the Metropolitan Asylums Board, one of its most energetic members—Sir Edmund Currie—stated that unless immediate steps were taken for the control of these epidemic diseases, they would probably return from their vacation to find themselves in the midst of an epidemic of small-pox and scarlet fever, with no means of coping with it. Already some 1,800 persons had died from the late outbreak of small-pox in the Metropolis. He believed that if prompt measures had been taken by the Local Government Board that epidemic would not have occurred. The small-pox epidemic had been less fatal at present than at any previous period of its prevalence; but the fact that the mortality was less than it formerly had been was no proof that they were at the end of their trouble. The Local Government Board were enabled by Act of Parliament to order the Metropolitan Asylums Board to construct hospitals for the reception of persons suffering from infectious diseases, and such an order had the effect of rendering it imperative on the Asylums Board to carry out their instructions, and any hospital so provided could remain where it was placed in spite of the protests of the people of the district. In March last a case was tried and carried to the House of Lords, in which it was declared by that tribunal that if it were proved that a small-pox or any other hospital for the treatment of infectious diseases was a nuisance to a populous district, it might be shut up, and that the order of the Local Government Board was no authority for keep- 405 ing it open. Since that decision of the House of Lords, the Metropolitan Asylums Board could do nothing in the way of establishing hospitals of that kind. By the Public Health Act of 1876 the Local Government Board, when an outbreak of infectious disease was threatened, could make, alter, and revoke regulations for the provision of medical aid and accommodation, and for guarding against the spread of the disease. His charge against that Board was that since December last, while an epidemic had prevailed, they had done absolutely nothing; they had refused to take any initiative or to give any advice. Had they been dealing with a threatened invasion of catttle plague, instead of small-pox or scarlet fever, they would have had the Vice President of the Council exerting himself to the utmost to cope with the apprehended visitation. In December last warning was given to the Local Government Board by the Metropolitan Asylums Board that small-pox was steadily increasing, and that something should be done. But nothing was done. In March, 1,500 applications for the admission of patients were obliged to be refused from want of hospital space. In May the Asylums Board themselves proposed to establish a hospital for small-pox convalescent patients at Darenth. The Local Government Board gave their assent. Later on a ship was placed at the disposal of the Asylums Board by the Admiralty, and that hospital ship was opened a couple of months ago. It might have been expected that a Department which was really the Department of Health in this country should know something about coping with dangerous epidemics. They had the outskirts of the Metropolis available to them, and also the river; but they were not resorted to until it was too late. There had been nothing to prevent the Local Government Board; and he said it was its duty to have advised the Asylums Board that all the thinly-in habited country outside of London, and also the river, lay open to them, where no nuisance would have arisen from the hospitals. If they had taken that course in time, a vast amount of the mischief which they had suffered would have been averted. The city which he had the honour to represent was an unhealthy one. Houses were crowded together; scores of families lived in some 406 tenements; and when epidemics broke out they spread with a virulence which happily was not manifested in London. But in Glasgow, during the last 11 years, although there was an epidemic which extended over five years, and although they had had repeated importations of the disease into the town, the mortality from small-pox had not been one-third what it had. been in London during the same period. The saving of life might appear trivial to some Members, but it was not so to him. In Glasgow during those 11 years the mortality was 1,590 persons per 1,000,000, whilst in London it was 4,580 persons per 1,000,000; or, taking the inhabitants of London at 4,000,000, the avoidable mortality in London—mortality from smallpox—in excess of what occurred in Glasgow was close upon 12,000. That was a startling fact, and it showed that they ought to adopt in London the same systems of supervision that existed in Glasgow. This was what was done in Glasgow. He knew a case where smallpox broke out in a tenement consisting of perhaps 60 or 70 families, and was only discovered on the death of one person. The medical officer, who there was entrusted with the entire control of epidemics, immediately on the case being reported to him, instituted a floor to floor and house to house examination, and he discovered that 24 cases had arisen from the one to which he had referred. The staff of vaccinators with which the medical officer of health was provided attended and offered to all the tenants and the members of their families the safeguard of re-vaccination, and in the result 200 to 300 persons were re-vaccinated; and owing to the steps thus taken, whereas 24 cases were infected from one case, not a single fatal case occurred. Why were not similar provisions made here to grapple with epidemics? Had that been done, the disease would never have spread to the alarming extent it had. It was no use putting out placards that people could be re-vaccinated at certain places. The people would not come. They must go to the people. Even where the people were disposed to come to the vaccinators, there was such difficulty in getting a supply of lymph that it had to be stopped. As in Glasgow, so in London, on the medical officer of health should devolve the whole responsibility; but he should be supplied with 407 everything in the way of remedy and everything in the way of assistance that he required. Such, however, was not the case; the trifling expense necessary for obtaining a due supply of lymph was not incurred, and no staff of revaccinators was provided. If this wooden system were to be allowed to prevail, they had better keep in the Treasury the £300,000 they were asked to vote, and leave it to private energy to face a danger the neccessary exertion for which, he believed, would have been put forth by the Government Department if it were cattle plague that had to be stamped out.

§ MR. DODSON

said, he understood the complaint of the hon. Member for Glasgow to be that the Local Government Board had not put in force the extraordinary powers for dealing with formidable diseases vested in them by the Public Health Act. As a matter of fact, however, it was not that Act, but the Prevention of Diseases Act that applied to the Metropolis; and it was evident that the abnormal powers given by that Act were only to be applied in a case of plague, or Asiatic cholera, or some unusual and terrible visitation with which the local authorities were unable to cope. He would therefore put it to the hon. Member and to the House whether in their view it was necessary, in the face of the events which had occurred, to exercise the extraordinary powers which were suggested by the hon. Member? As far as the question of house-to-house visitation was concerned, the Guardians in most instances had, with the approval of the Local Government Board, made provision for the purpose by appointing assistant vaccination officers, and the Vestries and District Boards had each of them medical officers, whose duty it was to keep them informed as to the condition of the health of the districts in which they were engaged. As regarded medical attendance for the poor, it was well secured through the agency of the Boards of Guardians, while the affluent classes of course provided for themselves. As to the speedy interment of the dead, not even the hon. Member would contend that any occasion had arisen for the exercise of extraordinary measures for that purpose. On the contrary, to have put forth the powers to which he had referred would have caused an unnecessary panic in the Metropolis, and would Lave been tantamount to proclaiming 408 martial law because of a disturbance in Hyde Park. He could not admit that the Local Government Board had shown any apathy in this matter. The Metropolitan Asylums Managers had responded most readily to the suggestions of the Local Government Board; but he was sorry to say that the Vestries and District Boards had done very little to provide hospital accommodation, as they were bound to, for persons not paupers who were attacked by infectious diseases. They were not, however, under the jurisdiction of the Local Government Board. It was all very well for the hon. Member for Glasgow to institute comparisons between the city which he represented and the Metropolis; but he seemed to forget that in the Metropolis there were difficulties, connected with its size, the fluctuation of population, the change of lodgings and other matters, which made it much more difficult than in Glasgow to discover or to follow cases in which the Vaccination Act might be evaded. As he had said, it was not possible for the Local Government Board to act directly; they only acted indirectly through the Metropolitan Asylums Board and to some extent upon other local bodies in the way of giving advice in such a manner as he had no doubt had produced, and would continue to produce, good effects on the health of the people. Since the Metropolitan Asylums Board had been established much had been done to provide hospital accommodation. The Board were bound to provide hospitals for the pauper class only; but in consequence of the general neglect of the Vestries and District Boards to do their part and provide hospitals for the non-pauper class, both classes had in the recent emergency resorted to the Board's hospitals. Even as it was, but for the closing of Hampstead Hospital, which had proved a great misfortune, the Asylums Board would almost have provided all the accommodation that was necessary. The Board had, including Hampstead, five permanent hospitals sufficient together for upwards of 1,000 patients. The closing of Hampstead had deprived the Board of 300 beds. To meet the difficulty thus created in the present epidemic, accommodation had been provided at Darenth for 600 convalescents, and a hospital ship, The Atlas, established, which could receive from 150 to 200 patients. As to vaccination, it was not the duty, nor was it in the power of 409 the Local Government Board to supply lymph by the pint or the quart for the vaccination of all persons. Parliament had not given it the means and did not intend to do so. The vaccinations which took place in England and Wales numbered 750,000 a-year. The Local Government Board could not provide lymph for all these. As it was it provided lymph stocks to about 10,000 medical applicants in the year. It had recently established a provision of animal lymph for the benefit of such applicants. In the endeavour to establish hospitals the Metropolitan Asylums Board had been greatly hampered by the objections made by the inhabitants of the districts where it was proposed they should be situated. This was shown by what had occurred at Hampstead, at Fulham, and at Wormwood Scrubbs. He must remind the hon. Member that the present epidemic was not nearly so severe as was that of 1871, and there was reason to hope that it would not be as severe as even that of six or seven years ago. Nevertheless, he could assure the hon. Member that he was by no means inclined to make light of the matter, and was desirous of using to the utmost the very limited powers that had been intrusted to the Local Government Board to deal with the matter, He trusted that the experience of the last few months would not be altogether thrown away either upon his Department or upon the Vestries and local authorities upon whom so much depended. He was far from finding fault with the hon. Member for Glasgow for having brought this subject under the notice of the House, because he was aware of the warm interest which the hon. Member took in sanitary matters; and he trusted that the effect of the discussion might be to stimulate the local authorities to exertion in dealing with these outbreaks.