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79
contact with small-pox, provided the members are properly protected by vaccination," and tbey
observe that " the evidence afforded during the epidemic is still to the same effect." It is the
Board's practice to insist on the re-vaccination 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 late epidemic the immunity enjoyed by the staff, of all
degrees, bears eloquent testimony to the effectiveness of re-vaccination when successfully carried
out.
Kensington Patients.—The admissions of borough cases in 1901 were 633 (613)*; viz.,
scarlet fever 370 (267), diphtheria 169 (240), enteric fever 49 (55), typhus fever 2, " other diseases"
43 (51). The deaths from all the diseases combined, were 48 (38), or 7.6 (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 persons
suffering from infectious disease is unlawful. Very rarely do we hear of the use of a cab, wittingly
or unwittingly. 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 of
extremely 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 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 on the application of any person
whatsoever, the sole condition being the presentation of a certificate signed by a registered medical
practitioner, as evidence of the nature of the disease, and the fitness of the patient for removal.
The application may be made personally, or by letter, or by telegraph, 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 : " 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 then provision of hospitals should
be extended so as to provide 5,700 beds; 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 over 3,860,000; consequently the recommendation of the Commissioners
went, to the extent of 1,740 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 resources of the
Asylums Board; 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
* Note that the italic figures in brackets are the corresponding totals for 1900.
† The ordinary provision was to be of 2,100 beds, but capable of being increased, on an emergency, to 2,700.