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Small-pox Hospital Accommodation.—The subject of hospital provision for small-pox,
referred to incidentally in the preceding paragraph, and also, in connection with the present
epidemic, at page 23, occupied a considerable share of the attention of the Managers of the
Asylums Board towards the close of the year, and especially in connection with a report of the
Hospitals Committee on the 2nd November. In view of the necessity for making increased provision
for acute cases with the utmost rapidity, the Committee recommended the erection of a
temporary hospital on the Managers' land at Long Reach, near the Ships, for 300 patients,
so as to raise the accommodation in that locality to 550 beds. The Managers adopted the recommendation,
and, moreover, authorised the Committee to take all necessary steps for equipping
temporary hospitals, and any other steps that might seem to them requisite, for making all
emergency accommodation available as rapidly as possible, and to communicate direct with the
Local Government Board on the Managers' behalf. With regard to Joyce Green, the Committee
explained that in July, 1896, the Managers submitted to the Local Government Board plans for
a hospital for 940 beds: the Board did not assent to the proposal, but a partial scheme, for the
erection of the whole of the administrative buildings for a hospital on this scale, received sanction,
and was then (and still is) in course of being carried out. The provision to be made for patients,
was at that date restricted to ten blocks, to contain 436 beds ; of the remaining 12 blocks, and the
isolation block, which together should accommodate 504 patients, the foundations and the drains
only had been laid, the contract price being £222,459. The Committee pointed out that the value
of the hospital would be more than doubled by the comparatively small cost (estimated at
£77,339) entailed in the completion of the whole of the wards, and they recommended, with a
view to steps being taken, to that end, as early as practicable, that it be an instruction to the
Works Committee to advise the Board as to the course that should be adopted for the erection of
the remaining 12 blocks for patients, and the isolation block. The recommendation was adopted;
the consent of the Local Government Board was obtained, and the work was put in hand forthwith.
Had this hospital been ready for use in 1901, I entertain little doubt that the accommodation
that would have thus been provided—a total of about 2,400 beds with those available at the Ships
and at Gore Farm—would have sufficed for the needs of the Metropolis. As it was, the Managers
felt constrained to make arrangements for still another hospital of a temporary character on a part of
the Joyce Green Estate site, where, at the present time, the " Orchard Hospital," for 800 beds, is
making rapid progress towards completion, at an estimated cost of £123,000 ; Long Reach Hospital
having cost £57,000. The actual present accommodation (April, 1902) is for about 1,750
patients ; the total will be raised to about 4,100 when the two new hospitals and certain additions
to the Gore Farm Lower Hospital shall have been completed. The estimated requirements
of the Metropolis, indicated bv the Royal Commission in 1882 (2,700 beds) will thus be seen to
have been far more than supplied. Whether so many beds for small-pox will ever be needed is open
to question : hitherto, during the present epidemic the total cases at any one time under treatment,
including manv extra-metropolitan patients, has not much exceeded 1,500. But, as before
hinted, any excess of accommodation provided, should be capable of profitable employment in
the event of a serious outbreak of fever or diphtheria.
Summary.—I am indebted to Mr. T. Buncombe Mann, Clerk to the Asylums Board, for the
subjoined statement of existing and projected accommodation for various classes of the infectious
6ick : it cannot fail to be read with interest.

* A proportion of the beds at the Gore Farm Lower Hospital is not immediately available.