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3. As respects accommodation for small-pox patients at Fulham Hospital,
I should be prepared to welcome a reduction in the maximum number of
beds to (say) 150, and I should be glad to have as many beds provided
for fever-patients, on a distinctly separated part of the site, a suitable
number of parishes being allocated to the hospital—say the four parishes
comprising the Borough of Chelsea, which contains a population of about
370,000, with the western suburb of London; overflow cases being admitted
from other districts only in emergencies.
4. I am of opinion that the Managers should provide additional hospitals,
raising the total to eight, and that they should be empowered to make
special provision out of London for convalescent cases of "fever" as well
as small-pox, so that the sick should not return to their homes until
recovery of health and strength is complete. To such convalescent
hospitals I would remove the patients as soon as removal could be effected
with safety. Separate convalescent hospitals at the Country sites should
be provided for fever and for small-pox cases. Accommodation, moreover,
should be provided for the reception and treatment of the
milder eases of modified small-pox, so that there should be treated
temporarily in Town, such cases only as could not be safely removed to a
considerable distance. Sanitary trains might be organised for the conveyance
of the sick.
5. The number of patients should be fixed, and in respect of small-pox
should not exceed 150 at each hospital. The strictest discipline should be
maintained, so as to provide against spreading infection through members
of the staff. Given a suitable site, with sufficient ward, floor and cubic
space, proper ventilation and disinfection, and complete isolation of
patients, nurses, and buildings, the recovery of the sick would be
promoted and the safety of the public secured.
Necessity of Isolation of Nurses.—Stringent restrictions should be placed on the
movements of nurses and other officers, who attend upon the sick in smallpox
hospitals; and the same remark applies in respect of persons who come
into contact with home-treated cases, and who should be forbidden to go
out of the infected house without bathing, disinfection of hair, and change
of clothing. Exposure in a public place of the clothing worn in the sick
room, previous to disinfection, should be made an offence, under Section 38
of the Sanitary Act, 1866.
6. The Sanitary Act 1866, Sect. 37, makes provision for hospitals for the
"sick inhabitants" to be established by Local Sanitary Authorities, singly
or in combination. The powers are permissive, and they have been
exercised to a very moderate extent indeed. It is probable that if the
powers had been generally exercised, difficulties would have arisen as in the
case of the Managers' Hospitals for small-pox patients, at Hampstead
and Fulham. But in 1867, the Metropolitan Poor Act was passed,
under the provisions of which the Managers have erected hospitals which,
as to number of beds, are nearly sufficient for London. Moreover, as
the arrangements for the construction of these hospitals were commenced