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as possible the accommodation required for the treatment of small-pox is the fact that the fever hospital
for the treatment of other infectious diseases, which the Council shortly hopes to open, will be in constant
use at all times, and will cause a considerable financial outlay annually.
The accommodation provided by the Metropolitan Asylums Board for small pox consists of 350 beds
for acute cases on the ships at Long Reach, and 800 convalescent beds in the hospital on land, making a
total of 1,150, and giving one bed to each 3,774 persons according to the last census. The Borough of
Sheffield has lately commenced erecting a small-pox hospital to contain 100 beds, situate four miles from
the borough, to replace the Borough Hospital in Winter Street, which was so unfavourably reported upon
by Dr. Barry. This provision gives one small-pox bed for each 3,330 persons. To equal the provision
made in the case of London and Sheffield, the Borough would require some sixty beds. It is true that
this number has been exceeded in the present epidemic, but as my periodical maps issued to the Public
Health Committee have shown, the epidemic has been almost limited to the district in which our hospital
is situated, and I am strongly of opinion that the fifty beds at the command of the Council at the
commencement of the epidemic would have been sufficient if the hospital had been some miles away. In
the case of a land hospital, should the accommodation be insufficient, additional accommodation of a
temporary character could be quickly erected. On the other hand, in the case of a ship hospital, the
accommodation to be provided must be equal to the largest possible demand likely to be made upon it, as
additional accommodation could not easily be acquired in the height of an epidemic.
(5.) Cost.—In order to estimate the relative cost of a ship hospital compared with that of a land
hospital, I have obtained information of the working of the hospitals under the Metropolitan Asylums
Board, kindly supplied me by T. Duncombe Mann, Esq.
I have also quoted below an extract from a paper by Deputy-Surgeon-General Bostock, C.B., and
Sir Vincent K. Barrington, contained in the Transactions of the Seventh International Congress of Hygiene
and Demography, dealing with this subject. The experience of the Metropolitan Asylums Board in dealing
with scarlet fever in land hospitals leads them to estimate the cost of treating and maintaining an individual
case (excluding the capital charges of the cost of buildings, etc.), at £15. The average stay in hospital of
scarlet fever cases from the East End of London is from nine to ten weeks. Now the average stay of a
small-pox case in hospital is not more than six weeks, and consequently the average cost of treatment of a
case of small-pox in a land hospital would be less. As will be seen from the paper quoted below, the cost
of each case of small-pox treated in the hospital ships during the 1884-5 epidemic is estimated at £23 5s.,
that is, at least one-third more than it would have cost if treated in a land hospital.
Extract of Paper on the Metropolitan Infectious Hospital and Ambulancc Organization.
The question is often asked, what is the cost of an epidemic, and what price do the ratepayers pay
for the means provided by the Metropolitan Asylums Board to limit, if not to prevent, the spread of
infectious disease in their midst ? The epidemic of small-pox described above may be taken as an example.
Great difficulty is experienced in answering this question correctly.
All the hospitals in London received both fever and small-pox patients in 1884-5, and no separate
accounts of the expenditure on each disease were kept, but an approximate estimate may be arrived at by
(i) setting down the expenditure on the establishments specially devoted to the reception of small-pox cases,.