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Association, and the St. John Ambulance Association. The Committee, in their report to the
Court, "having due regard to the public interest, and to the practical scheme propounded," expressed
the opinion that "it is most desirable that the Horse Ambulance System proposed by the
Commissioner be adopted in its entirety"; and they recommended that "it should be referred back
to them to give the necessary directions to carry out the scheme "—which provides for two
ambulance stations, serving the western and eastern portions of the City respectively; cases from
the western district to be conveyed to St. Bartholomew's Hospital, and those from the eastern district
to Guy's, and the London Hospital. The hospital authorities warmly support the proposal.
The report was agreed to, and referred to the Coal and Corn and Finance Committee to consider
and report on the question of ways and means. The importance of the matter is unquestionable—the
Committee stating that "the number of street accidents removed by the City Police to
the Hospitals for the five years 1900-1904," aggregated 9,761; an average of nearly 2,000 yearly;
" and of these only about one-half were removed on even hand-litters."
Both schemes—that of the Council and that of the Corporation—contemplate assistance
being rendered by senior hospital medical students, and nurses, accompanying the ambulances,
the male attendants of which, moreover, would be qualified to render " first aid."
Metropolitan Asylums Board Ambulance Service.—In the County Council scheme no reference
was made to the Metropolitan Asylums Board, whose work should not be left out of consideration
in any proposal for the establishment of a comprehensive Ambulance Service for London.*
The County Council, desiring power not only to "provide and maintain" an ambulance
service for street accidents, but also to "aid in providing and maintaining" such a service by other
authorities, it becomes an interesting question (as I observed in the sixth report) " whether the
* In the present state of the question, a brief history of the Board's Service may not be without interest:—
The Managers derive their powers to provide ambulances for the conveyance to hospital of the infectious sick, from
Section 16 of the Poor Law Act, 1879, which reads as follows:—
"The Metropolitan Asylums Board may, from time to time, provide and maintain carriages suitable for the conveyance of persons
suffering from any dangerous infectious disorder, and shall cause the same to be, from time to time, properly cleansed and disinfected, and may
provide and maintain such buildings and horses, and employ such persons, and do such other things as are necessary or proper for the
purposes of such conveyance.
"All expenses incurred by the Metropolitan Asylums Board in the execution of this section, to such an extent as the Local Government
Board may sanction, shall be paid out of the Metropolitan Common Poor Fund."
The power thus conferred was not exercised until after the Royal Commission on Infectious Hospitals (1882) had
expressed the view, in their "Practical Recommendations," that "the hospital authorities should have the entire control of
the ambulances, by which all other modes of conveyance should be as far as possible superseded." The Managers thereupon
lost no time in taking measures to give effect to this recommendation, which was accordant with the intention of the legislature
and with the views of the Local Government Board. But the ambulances were used exclusively for the conveyance of patients
to the hospitals of the Board.
It not infrequently happened in those days, that public vehicles (cabs, etc.) were used for the conveyance of persons
suffering from dangerous infectious disorders. Such use was not then unlawful, provided that the person hiring or using the vehicle
gave notice of the condition of the sufferer to the owner or driver, who had the right of refusing to convey the sick person
unless he should be indemnified for costs and expenses incurred by so doing ; viz., for disinfection, loss of time, etc.
It was felt at this time, and the feeling constantly grew stronger, that conveyance of infectious cases by public vehicles
should be prohibited by law; a proposition with which I concurred ; pointing out, however, that " provision should be made
for the conveyance of all infectious cases, by the Managers or other constituted authority, in public ambulances." In
December, 1884, I suggested, for the consideration of the Managers, "whether it would not be practicable to place their
ambulances at the service of the medical profession, and medical officers of health, for the conveyance of such cases, with or
without payment ? "The Managers replied that they were "not yet in a position to undertake the removal of any cases of
infectious disease beyond those which were to be received into hospitals under their own control." Two or three years later,
however, though they doubted whether they had " power to use their ambulances for other cases than those contemplated by
the Poor Law Act of 1879," they had become willing to take steps for obtaining " the power to undertake the general removal
of infectious cases in the metropolis."
The Poor Law Act, 1889, Sec. 6, enabled the Managers to allow the use of their ambulances for the conveyance of
persons suffering from any dangerous infectious disorder, to and from hospitals and places other than hospitals provided by
themselves, and to make (if they thought fit) a reasonable charge for that use. On 30th November, 1889, effect was given to
the new legislation by regulations prescribing the conditions on which the use of an ambulance could be obtained; provision,
moreover, being made for the attendance of a nurse for a fee of half-a-crown per journey, the charge for the ambulance being
five shillings; power to remit these charges, when deemed expedient, being reserved.
Proposed Non-infectious Service.—In November, 1903, the Managers informed the Local Government Board of their
willingness and ability to remove, to hospitals and elsewhere, urgent non-infectious cases—medical, surgical and insane—
without cost to the indigent, but on payment of a moderate fee for the well-to-do. Hitherto, the Local Government Boardr
have not taken steps to obtain from Parliament the necessary authority for the Managers, whose legal power extends only to
the removal, to hospitals or other places, of persons suffering from " dangerous infectious diseases "—an expression which has
been held to cover measles. Nevertheless, for some time past, the Managers' vehicles have been employed, occasionally, for
the removal to hospitals of non-infectious cases; to the number of 1,439 in 1905, including 134 medical and surgical cases for.
which a small fee was charged.