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83
To sum up, the accommodation existing or projected, far exceeds the theoretical requirement
of one bed for each thousand of the population. On that scale London would require not more
than 4,600 beds, and it has, or soon will have, 10,000. The Royal Commission in 1882, recommended
provision of 3,000 beds for fever—diphtheria was not included in the term. We now, or
soon shall, possess upwards of 6,000 beds. For small-pox they recommend provision of 2,100,
beds, or on an emergency 2,700, and we shall shortly possess nearly 4,000.
THE AMBULANCE SERVICE.
New Ambulance Station.— Many years ago the Managers constructed a Wharf and landing
stage at Wandsworth Bridge with the intention of removing small-pox patients in the West district,
therefrom, instead of taking them over a long and crowded route to the North and South Wharves.
This "West Wharf" has never been used, but towards the end of 1901 the Managers decided to
utilise the site by erecting a new Ambulance Station, the " Mead," which was rapidly built at a cost
not much below £30,000 but used for a few weeks only for the removal of patients.
Additions and improvements were made at the Shelters connected with the North and
South Wharves, for the embarcation of small-pox patients, at a cost of about £9,000; a new
Ambulance Steamer, moreover, was purchased at a cost of over £8,000.
The Managers now possess seven stations; and the Chairman of the Ambulance Committee
stated in January, 1902, that the Board were then in a position to convey 345 patients, in one day, to
the country hospitals, irrespective of removals to the town hospitals.
Transport of Small-pox Patients from London to the Small-pox Hospitals.—At the meeting of the
Asylums Board on March 8th, 1902, a resolution was adopted, upon the recommendation of the
Ambulance Committee, as follows :—
"That the Ambulance Committee be authorised to take all the necessary preliminary steps
with the view of securing sufficient freehold land, for the purposes of an ambulance station aud
shelters for patients, midway between Loudon and Gore Farm Hospital."
The recommendation was made in connexion with a previous report of the Committee (24th
February) in which, referring to the probability of the continuance of the small-pox epidemic
" through at least next winter, and perhaps with increased activity," they affirmed it to be
"essential that the transport arrangements should be perfected, so that under all circumstances
" patients may be conveyed to the hospitals." The river transport was said to be probably equal to
any demands that may be made on it under ordinary conditions, but " if a fog (the most likely
contingency) of some days' duration should occur, such as to render river navigation impossible, at
a time when large numbers of small-pox patients were being daily admitted, the service . . would
break down." Fog, however, was not the only " contingency," for in 1895 the ambulance
steamships were frozen up at South Wharf, from the 10th to the 23rd February, when, fortunately,
the admission of small-pox cases, during the 13 days, were 32 only, so that the steamships afforded
sufficient accommodation for them until the ice broke up. Dense fog, the Committee further
observed, "may occur at any time, and cause a stoppage of river traffic for days together," and they
pointed out that, at the daily rate of admissions (in February), the steamboats " would probably
only serve as a resting place for one day's admissions," so that it might some day " become
necessary to resort to road transit to the small-pox hospitals for every case admitted." For a large
number of cases this would be, with the present organisation, " hopelessly impossible." The
Committee thought, therefore, that " no time should be lost in considering and settling how
arrangements can be made whereby at a few hours' notice road transit can be set up and worked
efficiently to whatever extent maybe necessary." How serious the "problem" will be realized if
it is considered " what would be necessary to remove, say, 100 patients a day from their homes to
the small-pox hospitals near Dartford;" for, "if no better arrangement could be made than to carry
not more than two patients in one ambulance, the number of vehicles, horses, drivers, and nurses required
would be enormous." The bulk of the patients, moreover, "would have to be dispatched in the latter
part of the day, and the same vehicles could not be back and ready for use again the next day. It
was " practically impossible that the whole journey should be performed by the same horses,
nurses, and men, all of whom . . . would have to be housed and fed at the small-pox hospitals,
a complete duplicate of all horses, vehicles, and drivers being required for similar journeys the next
day." Therefore, a " half-way establishment seems to be a necessity, and this must probably be on
a considerable scale." The Committee's report concluded with the recommendation already cited
as having been adopted by the Managers.
A proposal of such gravity, and involving such serious issues to the patients—to say nothing
of the immediate expense in making provision of land, buildings, and plant—naturaliy attracted
considerable attention; it became, moreover, the subject of comment by the Medical Officer of