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is a growing disposition on the part of practitioners to get cases away while they are still
in a doubtful stage." On this the Statistical Committee observe, that if it be so, "and it
becomes a recognised practise for the Board's Medical Officers to admit 'suspected' cases of
infectious disease, it will have a most important bearing on the question of the amount of
isolation accommodation to be provided at the fever hospitals, and more especially in connexion
with the small-pox hospitals."
Ambulance Work.—The Ambulance Committee report that "the aggregate removals
during the year, including the transferring of patients from one institution to another, numbered
50,306*. The mileage run by the vehicles was 388,265. The work of the Western
Station comprised 8,076 removals, 5,588 journeys, and mileage, 63,266. "Under the powers
conferred by section 79 (3) of the Public Health (London) Act 1891, 405 persons suffering
from dangerous infectious diseases were conveyed to other places than the Managers'
hospitals." Four hundred and twenty-four non-infectious cases (medical and surgical) were
conveyed to general hospitals and other places; and. in addition, 734 imbeciles, 318 children
suffering from ophthalmia, 58 from ringworm, and 271 defective and other children, to the
Managers several institutions. Thus 1,807 non-infectious cases were removed—although as
the committee state "no formal authority for the extension of the ambulance service to the
conveyance of non-infectious cases has yet been conferred on the Managers." The committee
report that "further progress was made during the year in the substitution of motor for horse
traction for ambulance purposes," and with great advantage.
Local Ambulance Arrangements.—Kensington patients are removed to hospital by the
staff at the western station, which adjoins the Western Hospital, Seagrave Road, Fulham.
In 1900, the Managers, on removing to their new offices, Victoria Embankment (corner of
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 at night, on all days of the year.
Between 11 p.m. and 9 a.m., the ambulance stations are switched on to the public telephone exchanges,
so that "by making use of the telephone persons may obtain an ambulance at any hour of
the day or night." 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 2,100t 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 Commissioners' recommendation 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.
* Including the removal to the Managers' hospitals of 25,893 fever patients, and 33 small-pox patients.
† The ordinary provision for small-pox was to be 2,100 beds, but capable of being increased on an emergency to 2,700.