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cent., since the establishment of the first hospital in 1870,
together with extracts from the Registrar-General's Annual Summaries,
showing the annual mortality, per 1000 persons living of the
population of the Metropolis, from the several diseases, and the
annual average mortality from them for certain specified years before
and since the establishment of the Managers' hospitals.
Prefixed to the Committee's report there are spot maps showing
the localities in which cases were notified in 1891.
METROPOLITAN AMBULANCE SERVICE.
Section 16 of the Poor Law Act, 1879, now incorporated in
the Public Health (London) Act, 1891, 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 to 1879 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, who were but too frequently
removed in public vehicles, cabs, &c. The law did not forbid
the use of these vehicles for the purpose, provided that they
were afterwards disinfected. But the driver of a cab was often
unaware of the nature 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 totheconclusion that public vehicles should never beused
for this purpose, and that it would be to the public advantage to
make the Asylums Board the Ambulance Authority for
removal of the infectious sick of all classes. In 1884, therefore,
I addressed a communication to the Managers, proposing that