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the subject of legislation); the admission of patients, on whatever form of application, subject
only to the production of a medical certificate; gratuitous treatment; the popularity of the
hospitals themselves; and the increasing recognition by the public of the advantages accruing
from the isolation of the infectious sick. The operation of compulsory notification, moreover,
has been very effective; for now that the sanitary authorities become acquainted with, practically,
all cases of infectious disease, they are able to secure the admittance to hospital of numbers of
cases, such as in pre-notification days they would probably never have so much as heard of. In
connection with this important question it may be mentioned that so far back as the end of 1893,
the Managers had provided normal accommodation to the extent of about 3,000 beds for fever
and diphtheria patients, by the erection of additional temporary hospitals at Tottenham and
Lower Tooting. Since that date the Brook Hospital, for upwards of 500 patients, has been erected
and opened at Shooter's-hill, and the Park Hospital at Hither-green, Lewisham, also for upwards
of 500 patients. An equally large hospital, the "Grove," was opened in 1899 at Tooting, adjoining
the "Fountain" hospital. These three hospitals, for acute cases of fever, scarlet fever, and
diphtheria, and isolation wards, have added upwards of 1,600 beds to those previously provided
by the Managers, who, moreover, have acquired a site of 135 acres at Carshalton, Surrey, for a
convalescent fever hospital for 800 patients;* having already, at Winchmore-hill, north of the
Thames, at the Northern Convalescent Hospital, accommodation for about 050 patients. In
addition to the new hospitals on new sites, previously existing accommodation has been extended
and improved by the more or less complete reconstruction, with additions, of some of the older
hospitals. During the last few years the Gore Farm Small-pox Convalescent Hospital has been
used for fever and diphtheria convalescents, small-pox having been in practical abeyance in the
Metropolis. In September last the Managers of the Asylums Board informed the medical officers
of health that it would be necessary to close this hospital against fever cases, it being required
for small-pox patients. They observed that by the consequent loss of the beds, and of certain
accommodation held in reserve for a possible outbreak of plague, they had about 1,000 fewer beds
for fever purposes than in the preceding year, and this at a time when fever and diphtheria were
more prevalent than in 1900. The accommodation set apart for these diseases was, at the time,
practically exhausted, so that the Managers, it was expected, would be able to admit patients
only as vacancies might be made by discharges or deaths. The medical officers, therefore, were
requested to select for removal to hospital, until the height of the fever season should have
been passed, and the decline of fever and diphtheria enabled the Managers to admit all applicants,
only those patients whose surroundings rendered it most desirable that they should be isolated
in hospital. I ventured to represent to the Managers that it would be better, in the public
health interests of the Metropolis, to make provision for small-pox patients on their land adjacent
to the hospital ships—in huts, as at Darenth in 1881, than to suddenly deprive London of the
advantages accruing from the use for fever and diphtheria convalescents of the Gore Farm Hospital.
Similar representations were subsequently made by the Council, upon the advice of the
Public Health Committee, based largely on the consideration that the Hospitals Committee had
received authority to provide temporary accommodation for small-pox at Long Reach. A copy
of the Council's communication was forwarded to the Local Government Board, and to the
several Borough Councils, by some of which the views of the Council were endorsed in communications
to the Managers and the Local Government Board. The Board, in their reply to the
Council's communication, stated that "having carefully considered the matter, in view of the
present prevalence of small-pox in London, and of the possibility that plague may be introduced,
they did not feel able to recommend the Managers to adopt any course which would diminish
the amount of accommodation now set apart for those diseases. It is to be observed that, at
present (i.e., 16th November), Gore Farm is in use for the reception of convalescents from smallpox,
and the Board are advised that persons suffering from scarlet fever or diphtheria would incur
risk of contracting small-pox if they were treated on a site where cases of small-pox were at the
same time under treatment, or on one contiguous thereto."
The last paragraph of the letter indicates continued belief in the theory of "distal aerial
convection" of small-pox contagium; a theory which assumes that infective matter may be
carried through the air so as to infect persons at considerable distance from a small-pox hospital.
That small-pox was wont to prevail in the vicinity of such institutions is well-known—Fulham
Hospital is a classical example; and everybody is agreed that it is dangerous to maintain such
hospitals in populous localities. But at Gore Farm there are two hospitals, and, under careful
management, one might have been used for fever and diphtheria convalescents without danger
to the inmates from small-pox convalescents housed in the other. Be this as it may, Gore Farm
Hospital was lost to the Metropolis, for the time being, as a hospital for fever and diphtheria
convalescents; but, so far as I know, the Managers were able to provide, in other directions,
all the needed accommodation for these diseases. Certainly none of our cases were denied
admittance on the score of want of accommodation. Reference is made below to the huge
extension of accommodation for small-pox, with respect to which I shall only say, here, that
the hospitals now existing, or in course of erection, for that disease will, in the long run, find
their most useful application as institutions for the reception of patients, convalescing or otherwise,
suffering from fever and diphtheria.
* This hospital the building of which is shortly to be put in hand will comprise detached blocks, each to contain a
moderate number of patients, a desirable arrangement as it will diminish opportunities for the spread of disease, such as
post-scarlatinal diphtheria. The estimated cost is £284,312, including furnishing, &c.