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47
in a great measure, to an increased proportion of a better class
of the population dealt with." Until July of 1887 the great
mass of the patients received into the Managers' Hospitals
were the very poor ; but since that date patients of a higher
social condition have largely availed themselves of the hospitals,
due to the fact that patients have been admitted upon the
application of medical practitioners without the intervention of
Relieving Officers. The annual mortality-rates from small-pox
in London, during the past five years, have been far lower than
at any period dealt with in the Registrar-General's returns—a
fact explicable only, I believe, by the practice of removing
patients out of London to the Hospital Ships, thus effecting
perfect isolation and removing centres of infection from among
the population.
METROPOLITAN AMBULANCE SERVICE.
The Poor Law Act, 1879, sec. 16, conferred on the Asylums
Board one of its most valuable powers, that of providing ambulances
for the conveyance of the infectious sick to the Hospitals
of the Managers. Previously, the Boards of Guardians had
removed the sick in carriages, few of which were wholly satisfactory,
and under conditions occasionally prejudicial to the public
health. The work of removal—whether by land or water—is now
effected in an unexceptionable manner. In a former report, I had to
observe that this remark was applicable only in the case of patients
in course of transit to or from the Managers' Hospitals. It
was often quite otherwise in respect of private patients. The
law does not forbid the use of public vehicles (cabs) for the
removal of infectious persons, provided that the vehicles are
afterwards disinfected. But the driver of a cab may be unaware
of his fare's illness ; the efficacy of any practicable disinfection,
moreover, may be reasonably doubted. Consideration of these
and other objections to the existing law, led me to the conclusion
that cabs, etc., should never be used for this purpose, and that
it would be to the public advantage to make the Asylums Board