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expressive of their willingness to undertake the duty, the Chairman of the Board addressed a letter
to The Times (28th December, 1904), in deprecation of any assumption that the delay in the
establishment of a complete ambulance service was, in " anyway the result of the Board's apathy or
neglectthe Managers being, in fact, " very anxious to do all in their power to relieve the
sufferings of the sick and afflicted, and having the means to commence the service immediately the
necessary power is given to them."
The matter being to all appearance at a standstill, it appeared good to the Council, in
February last, to address communications to the Asylums Board and the County Council,
intimating the opinion that the "provision of an efficient and adequately equipped ambulance service
for London " was a matter of the utmost importance," and urging that " a definite decision should
be arrived at in regard to it as soon as practicable." The Managers lost no time in explaining their
position —showing that they had been striving for sixteen months to attain the desired object, as
regarded medical, surgical, and mental cases. What course the County Council will ultimately
adopt remains to be seen. The deputation, in May, 1904, were of the opinion that a Street
Ambulance Service could and should be worked in connection with the Fire Brigade; but it has
long been known that the Fire Brigade were averse from undertaking the duty; for reasons,
doubtless, of weight and validity, and there is ground for believing that it has now been definitely
settled that the duty will not be devolved on the Brigade. But how, otherwise, the Council will
achieve the purpose to which they are desirous to give effect, is at present unknown. That the
difficulty is great may be inferred from the fact that the labours of four years have not sufficed for
the attainment of a solution.
The simplest course, in my humble opinion, would be to have a single ambulance authority
for London, as a whole, the Asylums Board to wit, their experience in such work, for some twenty
years, having been on a scale of unparalleled magnitude. Given the necessary legal authority, they
could commence operations forthwith. They are, in fact, effecting no inconsiderable number of
removals of non-infectious cases at the present time—utilising some of the spare time of their large
staff; and, if empowered, would be able, at short notice, to organise a service for street accidents
and casualties. That the Managers would do this branch of the work efficiently goes without
saying; and surely, it would be the more economical course for the same authority to undertake the
other. From motives of delicacy, presumably, the Asylums Board have never put themselves
forward as being desirous to provide a street service ; but, in the interests of the public, it is to be
wished that they should signify their willingness to do so, and so solve the difficulty, and remove
the reproach of London's Municipal Administration.
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; but the Commissioners stated
in their Report (1882) that the provision of hospitals should be extended so as to provide 5,100
beds; viz.: 3,000 nominally for " fever," and 2,100* 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 1,240
beds (at the least), beyond the theoretical requirements of the day. But the Commissioners,
presumably, desired that provision should be made for a lengthened period in advance, and the
amount of accommodation they advised, is even now in excess of the standard requirement,
the estimated population being under 4,700,000; but circumstances not then 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 depauperization of medical relief in the hospitals, and the
opening of the several institutions to all classes of the people (measures 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. 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.
*The ordinary provision for small-pox was to be 2,100 beds, but capable of being increased on an emergency to 2,700.