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74
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 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 4,700,000. Circumstances, however, not then anticipated, have
led to largely increased demands on the resourced 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 admittance of patients, on whatever form
of application, subject only to the production of a medical certificate; gratuitous treatment;
the populaxity 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.

(8) Southern Hospital (at Carshalton) (about) 800 beds.*
It is thus seen that the accommodation far exceeds the theoretical requirement of one bed
for each thousand of the population : on that scale London would require not more than 4,700
beds; it has nearly 10,000, irrespective of the Southern Hospital.
*The ordinary provision for small pox was to be 2,100 beds, but capable of being increased on an emergency to 2,700.
*Vide page 44.