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73
wiser to remove a doubtful case than to have it outside, with the danger of infecting
others, which, if done, would of necessity increase the number of admissions, and thus
cause a very considerable expenditure of the rates. "In the Commitee's opinion" the
Managers would be going quite beyond the scope of their functions if they took any step
which would have the effect of discouraging medical practitioners from freely exercising
their judgment in seeking for their patients admission to the Board's Hospitals."
The Committee did "not see that any useful purpose would be served by a conference such
as had been suggested," and could "not recommend the Managers to take any part therein." The
report was adopted, and there was no conference.
The views expressed by the Hospitals Committee seem to me judicious, and will, I am persuaded,
commend themselves alike to the sanitary authorities and the medical profession.
Ambulance Arrangements.—Kensington patients are removed to hospital by the staff at the
Western Station, which adjoins the Western Hospital, Seagrave Road, Fulham, S.W In the early
part of 1900, the Managers, on removing to their new offices, Victoria Embankment (corner o(
Carmelite Street, E.C.), arranged for the reception there of applications for the removal of the sick
to hospital between the hours of 9 in the morning and 11 in the evening, on all days of the year;
so that it is now necessary to apply at the ambulance stations between 11 in the evening and 9 in
the morning, only. It cannot be too widely known that the sick are admitted on application, 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 by anyone, personally, or by letter, or by telegraph, or by telephone. The telegraphic
address is "Asylums Board London"; the telephone numbers are 2461 "Holborn," and
7181 " Central."
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, who, in their Report (1882)
recommended, 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 they desired, doubtless,
that provision should be made for probable requirements for a lengthened period in advance,
and the amount of accommodation advised, is even now in excess of the standard, the estimated
population being under 4,700,000. Circumstances, however, 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.
I am indebted to Mr. Duncombe Mann, Clerk to the Metropolitan Asylums Board, for the
subjoined statement, showing the existing and projected accommodation.
The ordinary provision for small-pox was to be 2,100 beds, but capable of being increased on an emergency to 2,700