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1881-2, and the Commissioners stated in their report (1882) that the then provision of hospitals
should be extended so as to provide 5,700 beds at the least; viz., 3,000 nominally for "Fever," and
2,700 for Small-pox. Diphtheria cases were not at that time admissible to the hospitals. The
population of London in 1882 was a little under 4,000,000 ; consequently the recommendation of
the Commissioners went, to the extent of 1,700 beds, beyond the theoretical requirements of the
day. The Commissioners, presumably, desired that provision should be made for a lengthened period
in advance, and the amount of accommodation they advised as necessary, is even now in excess of
the standard requirement, the estimated population being under 4,600,000. But circumstances
they could scarcely have anticipated have led to largely increased demands on the Managers'
resources ; not only by the sanitary authorities, but also by private medical practitioners and others.
Among these circumstances may be mentioned, the depauperisation 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. The operation of compulsory
notification, moreover, has had great effect; 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, such as in pre-notification days they would probably never have so much as heard.
In connection with this important question it may be mentioned that so far back as the end of 1893
the Managers had provided normal accommodation to the extent of about 3,000 beds, for fever and
diphtheria patients, by the erection of additional temporary hospitals at Tottenham and Lower
Tooting. Since that date the Brook Hospital, for upwards of 500 patients, has been erected and
opened at Shooter's-hill, and the Park Hospital at Hither-green, Lewisham, also for upwards of
500 patients. An equally large hospital, the " Grove," was opened in 1899 at Tooting, adjoining
the "Fountain" hospital. These three hospitals for acute cases of fever, scarlet fever, and
diphtheria, and isolation wards, have added upwards of 1,600 beds to those previously provided by
the Managers, who, moreover, have acquired a site of 135 acres at Carshalton, Surrey, for a
convalescent fever hospital for 800 patients,* having already, at Winchmore-hill, north of the
Thames, at the Northern Convalescent Hospital, accommodation for about 650 patients. In addition
to the new hospitals on new sites, previously existing accommodation has been extended and
improved by the more or less complete reconstruction, with additions, of some of the older hospitals.
Small-Pox Hospital Accommodation.—As regards accommodation for small-pox, the
Managers have not hitherto provided anything like the amount recommended by the Royal
Commission in 1882, viz., 2,700 beds. The Hospital Ships at Long Reach, on the River Thames,
furnish 300 beds for acute cases; whilst for mixed cases there is accommodation for about 1,200
patients at the Gore Farm Hospital, which, at the present time, is being utilised for scarlet fever
convalescents. The accommodation on this site could be materially increased, in case of emergency,
by the erection of temporary buildings, as also at the Joyce-green estate.
Summary.—I am indebted to Mr. T. Duncombe Mann, Clerk to the Asylums Board, for the
subjoined statement of existing and projected accommodation for various classes of the infectious
sick : it cannot fail to be read with interest.

* The building of this hospital will shortly b3 put in hand; it will comprise detached blocks, each to contain
moderate number of patients, a desirable arrangement as it will diminish opportunities for the spread of disease, such
post-scarlatinal diphtheria. The estimated cost is £204,548.