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returns and maps showed that a healthy neighbourhood in
which a hospital has been planted, though to a certain extent
injured, may yet be favourably compared as regards prevalence
of small-pox with those localities in which, from over-population
and neglect of sanitary precautions, the predisposing causes
of disease are more deeply seated.
In 1885 the Metropolitan Asylums Board began to convey
small-pox patients by steamer to the floating hospitals on the
Thames at Long Reach. In 1889 notification became compulsory
in London, and nearly all the reported cases of small-pox have
been promptly isolated in such a manner as not to occasion
infection from hospitals in crowded neighbourhoods. The comparative
immunity that London has enjoyed of recent years is no
doubt due to this policy which has been so vigilantly carried out
by the managers of the Asylums Board.
There are 400 beds in constant readiness at the ships, and
additional accommodation is available at short notice at Gore
Farm. On receiving telephonic or other communication at headquarters
an ambulance proceeds with a nurse to where the patient
is, and on receiving the certificate that the case is one of smallpox,
and without any compulsion, the patient is conveyed to the
wharf where the ambulance steamboat is in readiness. Here the
patient is seen by a medical officer of the Board, to confirm the
diagnosis or otherwise. There are three ambulance steamers
comfortably fitted up so as to carry 100 acute cases at a time.
It is a matter of experience that it is easier to secure
notification and isolation in the case of small-pox than in the case
of any other infectious disease. The promptness and ease with
which an outbreak of small-pox in Marylebone was dealt with
successfully by the Board, in 1894, afforded a striking illustration.
The Asylums Board has no jurisdiction in regard to
disinfection or vaccination, nor is there in London any machinery
for quarantining the inmates of infected households. Investigations
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