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advocated in these reports many years before they formed 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, of which in pre-notification days they would probably
never have heard.
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, with isolation wards, 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 650 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 1901, 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 Board 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 suddenly to 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, however, 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."
The Gore Farm (Upper) Hospital was utilized for small-pox cases, acute and convalescent,
from October 1901 until the end of the epidemic. Happily no inconvenience resulted from its
closure to fever and diphtheria, the town hospitals having sufficed for all requirements
Proposed Additional Fever Hospital Accommodation.—'In June, consideration was
given by the Managers to the question whether further accommodation was needed for fever and
diphtheria. They had been advised that the Board should be in a position to deal with 20,000
cases of scarlet fever in a year,+ and that to enable them to do so 5,700 should be the minimum
number of beds provided, while probably 2,000 would be needed for diphtheria, ‡a total for these
two diseases, and the isolation and separation wards connected therewith, of (say), 7,700 beds
* This hospital, the building of which is now in progress, 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 postscarlatinal
diphtheria. The estimated cost is £284,312, including furnishing, &c.
† In 1893, 36,900 cases of scarlet fever were notified ; in 1901 about 84 per cent. of cases notified were admitted to hospital.
‡ In 1899, 13,363 cases of diphtheria were notified ; in 1901 about 76 per cent. of cases notified were admitted to hospital.