HL Deb 30 May 1892 vol 5 cc173-6



My Lords, I beg to ask Her Majesty's Government a question in regard to a circular that was issued the other day by the Metropolitan Asylums Board in regard to their small-pox hospitals. The authorities of a large general hospital in London, with which I am connected, received, and therefore I have little doubt the other hospitals received, a circular saying that they were willing to receive two clinical assistants on board the small-pox ships, and three probationer nurses. These clinical assistants were to be registered medical men and to be under the Board's rules, and so forth; the remuneration was to be limited to the allowance of residence and rations, and an appointment for a period not exceeding three months. In regard to the nurses they are to have no salary, but merely a uniform, rations and lodgings. Now, my Lords, I do not think that it seems a good principle for a great institution like the Metropolitan Asylums Board to advertise for medical men and nurses to whom they are not to give any pay at all. In the first place, they are not likely to got first-rate men, and it comes much harder upon the nurses. Smallpox is the most dangerous disease there is, and I cannot help thinking that this circular cannot have been issued with the sanction of the Metropolitan Asylums Board, or, at any rate, with the sanction of the Local Government Board. I should like to ask whether it has come to the knowledge of the Local Government Board, and whether it is done with their sanction; and if this circular has not been issued with their sanction, whether they will cause some representations to be made to the Metropolitan Asylums Board?


My Lords, the Local Government Board were not aware of this circular letter having been issued until the question of my noble Friend opposite was put down on the Paper; but they have made inquiry, and they find that a circular letter was addressed to several of the general hospitals in London. As regards the clinical assistants, this is not a new question; it was brought before the Board in 1886. It was then proposed by the managers of the Metropolitan Asylums District that they should be empowered to arrange for registered medical practitioners to reside in the hospital on condition of their making a payment at the rate of twelve shillings a week for board and lodging and the payment of a fee to the medical superintendent. It appeared at that time to the Local Government Board that this was not at all a desirable arrangement, and they suggested to the managers that if the services of clinical assistants were required, it would be better that such assistants should be appointed by the managers as officers of the hospital, and that they should receive remuneration for their services, although such remuneration might, if the managers deemed it expedient, be limited to board and residence in the hospital. The object of the managers in proposing this arrangement, and of the Board in agreeing to it, was that means might be afforded to a limited number of medical practitioners of obtaining experience in the treatment of small-pox cases. The managers would have in connection with the hospital their regular medical staff for the treatment of the cases, and the clinical assistants would no doubt render assistance; but the primary object of the arrangement was not that the staff of officers of the hospital should be supplemented by assistants of this character, but that means should be afforded to medical practitioners of obtaining experience in the treatment of small-pox cases. As regards the nurses who are to be employed as probationers the Board have had no communication on the subject from the managers in any way. But as regards them also it may be assumed that the managers desired to afford opportunities for nurses to obtain experience with regard to the treatment of this disease quite independently of the assistance rendered by such probationary nurses. I believe the probationary nurses are not given technical education at first; they are gradually worked up to better positions; but independently of the assistance rendered by them the managers have their own staff of nurses. So far as regards the nurses the matter is one which the Local Government Board consider to be entirely within the discretion of the managers, and they would hesitate to intervene unless for some very substantial reason. The Board, in fact, are not aware whether it is probable that the offer which has been made by the managers will be accepted; but if it is accepted by suitable persons, and assuming that it is an arrangement which is satisfactory both to the managers and to the persons willing to give their services on the terms offered, the Local Government Board see no reason why the proposal should not be carried out; in fact why they should interfere in the matter.


I am afraid the conduct of your Lordships will be rather inconsistent if you approve of this Order which has been made by the Metropolitan Asylums Board. A Committee of your Lordships sat for two years upon the subject of Sweating, and are now sitting upon the subject of Metropolitan Hospitals; and both Committees have altogether condemned the principle, that the mere fact that you can get persons in a certain profession to serve for nothing is a reason why any Government, or quasi-Government, or Municipal Board should make service without remuneration a condition of their engagement of subordinates. Take the very case mentioned to-day. We all know that in the Government contracts for clothing a clause is inserted that the workmen should be paid a certain rate of wages. We all know that on the Sweating Committee we condemned in the strongest possible terms—and your Lordships assented to the condemnation—the employment of persons for nothing or for inferior wages. What is the real meaning of this order? Undoubtedly there will be found inferior practitioners who, in order to gain a name for small-pox treatment, will accept the invitation. I really do not think that is a temptation which a Government or a Municipal Board ought to offer to the medical profession. With respect to probationer nurses, I rather think it is still harder upon them. These women have undertaken most dangerous duties; in the various hospitals they are invariably paid for their work; and why should they be tempted, in order to gain a little reputation, to enter upon dangerous duties without that remuneration which is always given to everybody else employed in Government or Municipal service? I really hope the Local Government Board will consider this Order, and take care that it is amended.