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PROTECTING the Health of LONDON'S POPULATIOIN

14th May 1929, Page 68
14th May 1929
Page 68
Page 69
Page 70
Page 68, 14th May 1929 — PROTECTING the Health of LONDON'S POPULATIOIN
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ElVERY case of the more

A I important infectious diseases occurring in the metropolitan area of London must be brought to the notice of the medical officer of health of the district in which it occurs, and the majority of these cases is admitted to the hospitals of the Metropolitan Asylums Board. The Board receives approximately 95 per cent, of the cases of scarlet fever and 98 per cent. of the cases of diphtheria occurring in London.

On discovering that a patient is suffering from an infectious disease which requires hospital treatment, the doctor in attendance telephones either direct or through the local medical officer of health to the headquarters of the Metropolitan • Asylums Board, requesting that an ambulance proceed instantly to the address of the patient. Whether it be day or night, one of the Board's ambulances, with a nurse, will be under way within a few minutes. The patient will be conveyed to one of the nine "acute fever hospitals" of the Board, which are located in London, or, if a smallpox case, to one of the three reception stations in London, whence, after confirmation of diagnoses, he will be rapidly removed to the smallpox hospitals situated at Long Reach, Dartford, in Kent.

Patients suffering from other diseases, such as tuberculosis, or acute rheumatism, orthopmlic cases, and those convalescing after recovery from infectious or other illnesses, are conveyed by motor to the Board's convalescent homes, which are situated over an area extending from Lowestoft and Margate in the east to Wokingham in the west and Littlehampton in the south.

As there are over 4,500,000 inhabitants in the metropolitan area, and the Metropolitan Asylums Board has always some 19,000 patients in its care, most of them requiring day and night nursing, it is not surprising to learn that the Board has now a staff of approximately 9,500 persons.

In dealing with cases of highly infectious disease, the greatest expedition in the matter of transport is, of course, imperative, and the ambulance work of the organization must be efficient and prompt in response to calls.

Although constituted in 1867, the Metropolitan Asylums Board was not authorized until much later to undertake the conveyance of its patients. In 1881 a service of horsed ambulances was inaugurated. In 1902 the first mechanically pro pelled ambulance was introduced, this being a Thornycroft steamer with chain final drive. Now the Board has a fleet of 144 vehicles, chiefly ambulances and buses of Clement-Talbot, Crossley and W. and G. makes. These are mainly housed in depots adjoining six of the "acute fever hospitals," situated at Hampstead, Homerton, Woolwich, New Cross, Stockwell and Fulham.

An impression of the volume of good work done is obtained when we consider that in 1928 the mileage covered by this fleet was 1,146,714 and 199,944 persons were conveyed. Of this number 96,787 were patients, mainly suffering from serious infectious diseases or requiring urgent medical or surgical attention, the remaining passengers being members of the staff engaged on various duties.

The arrangement at each of the six ambulance stations is such that even during the night there is an adequate staff on duty. The men, who work in shifts of approximately eight hours each, are all trained in first aid and as stretcher-bearers, as well as being experi enced drivers.

From this very brief description of the 'work under taken by the ambulances it will be seen that a centra maintenance depot and a system of checking the mechanical condition of the vehicles at very frequen intervals are essential to secure the unfailing operation of this urgent work. There is, indeed, a very remarkable maintenance depot and bodybuilding works on the Thames Embankment at Wandsworth Bridge, where Mr. C. L..Sladden, who is responsible for the mechanica condition of the fleet, centralizes his organization.

Maintenance Simply Supervised.

To ensure that all the vehicles are in a condition of absolute reliability, Mr. Sladden has instituted a system of cards, upon which every detail of defective running of adjustment and repair, of replenishment and over haul is entered. At each of the depots is a box o these cards, one card relating to each vehicle, on which

are entered, by one of the three mechanics at the depot the date and the speedometer reading on every occa

sion when the engine oil has been changed, when the various chassis greasers have been replenished am when the vehicle has been generally inspected. The engine oil is renewed every 5,000 miles, gearbox and back axle are replenished with lubricant every 1,000 miles and the vehicle is inspected by the heed mechani after every 1,000 miles.

Another box at each depot contains drivers' defect cards. On one side of the defect card is a list of 44 possible chassis defects and 23 possible bodywork and equipment defects. Whenever a driver finds any defect whatever in a vehicle which he takes out he fills in one of these cards, putting a cross in the appro priate place on the list of faults and filling in details of the time and place where the deficiency was dis covered. On the other side of the card is a space in which the head mechanic of the depot records all that he discovered in investigating the defect and the steps he took to remedy it.

As mentioned above, each vehicle is taken out of service for some hours after every 1,000 miles and the senior mechanic at the depot goes through a formula of 55 items of inspection which are listed on another card.

After every 20,000 miles the vehicle is completely overhauled at the works depot, is repaired and repainted, and the equipment is brought up to date.

The fourth card is one on which the history of every tyre is recorded, the object of this being to avoid delay in the transport of a patient, which might be caused in the event of it being necessary to change a tyre on the road. In addition to the fleet of ambulances the Metropolitan Asylums Board operates 22 goods. vehicles, including S.D. Freighters, Thornycrofts, Leylands, Daimlers and A.E.C.s and a fleet of about 15 ambulance buses.

It is natural that in a fleet with ,such a• history as that of the M.A.B. there are vehicles of many different kinds. The type of vehicle, however, which is being 'acquired now to replace old ambulances follows the design which was settled upon in 1926, when a complete ambulance was constructed under Mr. Sladden's direction at the maintenance depot.

The Latest' Type of Ambulance.

The chassis of the latest ambulances is made as low and as wide as possible so as to accommodate a large and commodious body, the loading height being only 1 ft. 8 ins. The differential box is offset so that the inevitable dome in the floor above the casing comes under the stretcher on the near side of the vehicle and does not in any way interfere with the movement of stretcher-bearers when carrying patients into or out of the vehicle.

The engine is a six-cylindercl side-valve unit and the chassis recently supplied were construeted.7.Thy W. and G. du Oros, Ltd. The principal difficulty in the design of the ambulance has been to obtain the ideal body length of not less than 8 ft. without excessive overhang or an over-long wheelbase. This has been done, however, by setting the radiator, engine and driving seat well forward. Very long semi-elliptic springs are used, those at the rear being 5 ft. in length.

The interior is arranged for the accommodation of either one or two stretchers. When one stretcher only is required the stretcher platforms on the off side are removed and a nurse's seat is fitted ; when, however, two stretchers are to be accommodated a nurse's seat is placed between them. A wash-hand basin supplied with antiseptic water from a two-gallon tank, a cupboard with sick-room utensils, a thermos flask, adjustable purdah-gIass windows and hot-water pipes fed from the engine-cooling system are features of the latest vehicles. Stretchers and nurses' chairs are nowadays fitted with mattresses, cushions, etc., of the sponge-rubber type, which, apart from being comfortable, are very easily disinfected.

In conclusion, it should be mentioned that, in addition to the public-health work which the Metropolitan Asylums Board ambulances perform, they may be privately hired for surgical and medical cargas, and, in this capacity, the ambulances travel extensively in and near London. The charge for private hire for conveyance of a single patient between any two addresses in the Metropolitan area is 10s.

Tags

People: Sladden
Locations: London

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