View report page

33
the Council, it did appear, looking to all the surrounding facts of the case, that this arrangement would be
the most simple, advantageous, and economical. On enquiry, however, I soon discovered that the Metropolitan
Asylums Board could not entertain such a proposal, since when I have ceased to consider it
practicable at present, although for reasons which will become more evident towards the end of my report,
I am still of opinion that in the treatment of this one disease only, looking to the increasing populations of
the extra-metropolitan districts, an arrangement such as is suggested above would be the most efficient,
even if more costly than a land hospital, for the districts of West Ham, East Ham, and Leyton.
The treatment of small-pox from a municipal point of view may be considered under five
headings:—
(1.) Efficient vaccination.
(2.) Prompt removal from home.
(3.) Complete isolation from crowded districts.
(4.) Ample accommodation for patients and staff.
(5.) Strictest economy of cost, compatible with thorough performance of the previous
four.
Under these headings I propose to compare ship and land hospitals.
(1.) Vaccination. All sanitarians are agreed that small-pox epidemics are more quickly controlled
by efficient vaccination than by removal to hospital or by any other treatment, and it is to be hoped that
in the near future local authorities may be in a better position to control this most important preventive
measure than they are at present, but as this subject does not affect the question at issue between ship and
land hospital, it may be left with a mere mention.
(2.) Small-pox being highly infectious from its very commencement, prompt removal from home
becomes at first essential. On receipt by the local authority of notice of the existence of a case of smallpox,
the patient should be on the way to hospital within a few hours. It is evident that for this purpose
not only must the hospital be ever in readiness to receive patients, but also that the ambulance or other
means of conveyance to the hospital must be ever in readiness. In the case of a land hospital the prompt
removal is simple, our ambulance being ever ready for use. In the case of a ship hospital, beside the
ambulance journey from home to the landing-stage, the patient will require the constant readiness of a
steamer for removal from landing-stage to ship hospital. In the communications made to the Council by
Mr. Hudson, the naval architect, whose advice the Council obtained in connection with the question of
converting a ship into a small-pox hospital, certain figures (which will appear later) being the salaries of
officials (captain, mate, &c.) appointed to the River Transit Service are given, and it was suggested that
when no small-pox existed in West Ham, a shipkeeper could supervise, cleanse, and maintain the steamer.
Such an arrangement, however, strikes at the foundation of successful hospital provision. The varied officials
to man the river service could not be obtained at a moment's notice, and unless they are in constant
attendance, and ready to remove isolated cases at any time, the hospital will be robbed of a great part
of its value. This point must be borne in mind in considering the question of maintenance, as it
tends largely to increase the cost of a ship hospital as compared with a land hospital. One other
point under this heading for consideration, is the risk of spreading infection in transit. The
ambulance can be driven direct from the patient's home to the land hospital without stoppage,
but to reach the landing-stage at Manhattan Wharf, which is the only available place of embarkation
in West Ham, there are two routes. On both these routes the ambulance may be delayed
for a quarter of an hour at two places, namely, the Tidal Basin Railway crossing, the Tidal Basin