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(i.) Prefatory note by Sir William J. Collins, chairman of the Ambulance
Sub-Committee of the General Purposes Committee.
1. A consideration of the ambulance service of London naturally falls under the following
heads, viz.—
(а) A description of the existing services.
(b) The question as to whether or not these are adequate.
(c) A comparison with the systems in operation in other cities and towns.
2. The existing services.—The medical officer's report sets out in some detail the present services
from which it will be seen that these are in the hands of the following—(i.) the police; (ii.) the St.
John Ambulance Association; (iii.) the Bischoffsheim service and (iv.) the Volunteer Medical Staff
Corps.
The police, who in most cases have the first handling of street accidents, are provided with
hand-stretchers and wheel-litters, and opportunity is afforded to constables for instruction in first-aid.
For rapid transport only three horsed-ambulances exist, maintained by private effort, at Rochester-row,
Carter-street, and Stoke Newington police-stations, and a charge is made to the public for their use to
cover the payment for the horse, driver and cleansing; these are not kept in constant readiness, but on
each occasion when requisitioned a horse and driver are supplied from a contractor. The St. John
Ambulance Association trains in "first-aid" and provides litters and appliances at certain fixed
stations, but except at three of these no officer is on duty. The Bischoffsheim service also provides
at fire brigade stations and other fixed points wheeled litters and stores, but has no officer on duty.
The Volunteer Medical Staff Corps renders valuable ambulance service on rare and special occasions
such as public processions. Thus, so far as accidents are concerned, horsed-ambulances are practically
non-existent in London.
Although much is done by these organisations, there is no uniform adequate and co-ordinate
system for dealing with street accidents in London and no central supervising authority in quick touch
on the one hand with casualties as they occur and on the other with the hospitals in which they can
receive prompt attention. In out-lying districts there are naturally fewer facilities than in central ones
for dealing with street casualties. The telephone is not utilised. On the other hand the ambulance
arrangements for the conveyance of those certified to be suffering from infectious diseases are already
adequately provided by the Metropolitan Asylums Board, and are in striking contrast to this lack of
provision for street casualties,
3. Question of adequacy.—In order to ascertain what are the actual means at present in vogue
for the conveyance of persons suffering from the results of accidents or sudden illness in the streets or
other public places, the Sub-Committee placed itself in communication with the metropolitan
hospitals, some 30 of which receive such cases in London. A record was kept, at the request of the SubCommittee,
at several of the large London hospitals for a period of four weeks, of the actual mode in
which cases of accident and other casualties were brought to the hospitals. Of 994 injured persons
arriving at 10 hospitals otherwise than on their own legs, 642 came in cabs or carts, 302 in
different kinds of ambulance, and 50 by other means of conveyance. That is to say nearly 70 per
cent, of the casualties at present conveyed to hospitals by some vehicle or other are taken in cabs
or carts and not in ambulances.
From the figures that have been furnished for the year 1899, it would appear that nearly 10,000
street accidents are dealt with by the metropolitan police in the course of the year. In the E division
during the six months ended February, 1902, the police ambulance was used 110 times, the
Bischoffsheim ambulances 56 times and cabs 120 times.
No witness who appeared before the Sub-Committee considered that the present system of dealing
with street casualties in London was adequate. Nearly all advocated the use of more rapid means of
transport of the sufferer to the hospital. Horsed or motor ambulances, either in addition to or in
substitution of hand stretchers and litters, were recommended. The use of cabs or carts for casualties
where the nature of the injury was either undetermined or such as to be likely to be complicated or
augmented by placing the injured person in a cab was condemned by all. Dr. Perry, the superintendent
of Guy's Hospital said "it is very painful to watch' the arrival of accidents at hospitals
under the present system." The use of the telephone for prompt summons of rapid means of transport
to the injured, and his equally prompt removal to hospital were suggested rather than the elaboration
of means of treatment on the spot.
4. A comparison with the ambulance systems in provincial and foreign cities and towns.—
From the Medical Officer's report it would appear that in some provincial towns and in certain
Continental and American cities more modern and efficient systems of ambulance service are at work
than is the case in London.* Horsed ambulances summoned by telephone are employed at Liverpool,
Birkenhead, Manchester, Newcastle, Huddersfield, Bolton, Burnley, Hull, Sheffield, Leeds and Wolverhampton.
In some cases the police, and in others the fire brigade, have the working of the
ambulances. The system introduced by Captain Wells, by means of which telephonic messages may
be sent from fire-alarm posts, and which has been adapted to the 792 posts in London, has
been utilised in Liverpool for the purpose of summoning ambulances in case of street casualties.
The mode in which this has been effected will be found in an appendix to Dr. Collie's evidence on
page 32. In New York, Now Orleans, Paris and Vienna there are organised systems of town
ambulances well worthy of attentive study (see pp. 16-20).
* Sec also article on "Horsed Ambulances," by Hon. Dudley Leigh in "Nineteenth Century," October, 1896.