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typhus 2,351; enteric 15,632; other diseases 16,048; total 244,206. Of small-pox cases the
admissions (1871—1900) were 62,145, including 13,139 between February 4th, 1871, and January
31st, 1872. Decreased percentage of mortality amongst scarlet fever patients is a noticeable
feature; but more noticeable is the decline in the percentage mortality amongst diphtheria
patients—from 40'74 in 1889 to 29.29 in 1894; to 22.85 in 1895 (when the anti-toxic serum treatment
was first adopted); to 21.2 in 1896; to 17.69 in 1897; to 15.38 in 1898; to 13 95 in 1899, and
to 12.27 in 1900.
Staff Illness.—There were 4,333 (4,765)* persons employed at the fever hospitals during the
course of the year 1900, of whom 216 (243) or 4.9 (5.1) per cent. fell ill with fever or diphtheria,
and 3 (3) died, while 1,397 (1,280) or 32'2 (26.8) per cent. suffered from other forms of illness.
The Committee, in their report for 1892, pointed out that nurses and other members of a
hospital staff could be brought with almost absolute impunity into contact with small-pox,
provided they were properly protected by vaccination; and the evidence of each succeeding year
has confirmed them in that opinion; it being the Board's practice to insist on the revaccination of
all officers and servants before they join the hospital or ambulance service—unless they can
satisfy the medical superintendent that they are already sufficiently protected. During the
current epidemic the immunity enjoyed by staff, of all degrees, bears eloquent testimony to the
effectiveness of revaccination when successfully carried out.
Kensington Cases.—The admissions of Kensington patients were 613; viz., scarlet fever,
267; diphtheria, 240; enteric fever, 55; "other diseases," 51. The deaths, from all diseases
combined, were 38, or 6.2 per cent. on admissions.
Removal of the Sick to Hospital.—The removal of the sick to hospital, whether by
land or by water, is now effected in a satisfactory manner. The use of public vehicles by, or
for, persons suffering with infectious disease is unlawful. Occasionally we hear of the use of a
cab, wittingly or unwittingly, and in such cases the vehicle is usually lost sight of before discovery
of the nature of the illness, and so does not get disinfected. This is no doubt a danger to
the public, but it is now of rare occurrence compared with the time before the passing of the
Public Health (London) Act, 1891; the 70th section of which forbids the employment of public
vehicles. No case of wilful breach of the law came to my knowledge during the year.
Ambulance Arrangements.—Kensington patients are removed by the staff at the
Western Station, which adjoins the Western Hospital, at Seagrave-road, Fulham. In the
early part of 1900, the Managers, on removing to their new offices, Victoria Embankment (corner
of Carmelite-street), E.C., arranged for the reception of applications for the removal of the sick
to hospital between the hours of 9 in the morning and 8 in the evening, on all days of the year;
so that it is now necessary to apply at the ambulance stations between 8 in the evening and 9
in the morning, only. It cannot be too widely known that the sick are admitted to hospital on
the application of any person whatsoever, the sole condition being the presentation of a certificate
signed by a registered medical practitioner, showing the nature of the disease, and the fitness of
the patient for removal. The application may be made personally, or by letter, or by telegram,
or by telephone. The telegraphic address is "Asylums Board London": the telephone numbers
are 1601 and 1602, " Holborn."
HOSPITAL ACCOMMODATION.
In the annual report for 1893 (pages 117—130 inclusive), I dealt with "The Needs of
the Metropolis in respect of Hospital Accommodation for the Infectious Sick"; detailed the
steps taken by the Asylums Board to supply the then existing deficiencies, and referred to the
difficulties by which their efforts had been confronted and, to a certain extent, foiled. Those
difficulties have now been largely overcome; and the needs of the Metropolis have been met to
an extent beyond my estimate of them, made in the tenth monthly report for 1892, which, at the
time, was thought to be excessive; viz.; "at least 5,000 beds for scarlet fever, 'fever,' diphtheria,
and isolation."
Fever Hospital Accommodation—It is an accepted axiom that provision for the isolation
of infectious disease should be made at the rate of not less than one bed for each thousand of
the population. The subject, as regards the Metropolis, was dealt with by the Royal Commission
in 1881.2, and the Commissioners stated in their report (1882) that, the then provision of hospitals
should be extended so as to provide 5,700 beds at the least; viz., 3,000 nominally for
"fever," and 2,700 for small-pox. Diphtheria cases were not at that time admissible to the
hospitals. The population of London in 1882 was a little under 4,000,000; consequently the
recommendation of the Commissioners went, to the extent of 1,700 beds, beyond the theoretical
requirements of the day. The Commissioners, presumably, desired that provision should be
made for a lengthened period in advance, and the amount of accommodation they advised, as
necessary, is even now in excess of the standard requirement, the estimated population being
under 4,600,000. But circumstances they could scarcely have anticipated have led to largely
increased demands on the Managers' resources; not only by the sanitary authorities, but also
by private medical practitioners and others. Among these circumstances may be mentioned,
the depauperisation of medical relief in the hospitals, and the opening of the several institutions
to all classes of the people (measures advocated in these reports many years before they formed
* Note that italic figures in brackets are the corresponding figures for 1899.