A brief history of healthcare provision in London


The smallpox epidemic which began in 1881 placed great strain on available hospital beds.  To create more bed space the Metropolitan Asylums Board (MAB) chartered two old wooden warships from the Admiralty; the Atlas, a 91-gun man-of war built in 1860 but never fitted out for use at sea, was to be used for acute cases, and the Endymion, a 50-gun frigate built in 1865, would be the 'administration block' and storeroom.  These were converted at the cost of £11,000.

Originally MAB wanted to moor the ships at Halfway Reach, near Dagenham, but the Thames Conservancy, who were responsible for the river, insisted that they be moored off Deptford Creek in Greenwich, near where the hospital ship Dreadnought had been sited.  

The first patients were admitted on board the 120-bedded Atlas in July 1881.  By the end of the epidemic in August 1882, almost 1000 patients had been treated on the ship, of whom 120 had died.

A Royal Commission had been appointed to look at the arrangements for infectious disease patients due to growing public concern about the spread of infection to houses in the vicinity of isolation hospitals.  Its report, published in 1882, recommended that smallpox patients should be treated in isolation hospitals along the banks of the Thames, or in hospital ships on the river itself, and that their convalescent hospitals should be sited in the countryside at some distance from urban areas.  The Commission also recommended that a central ambulance service should be established.

Following this report, the smallpox hospital ships Atlas and Endymion were moved in 1883 from Greenwich to new moorings at Long Reach, some 17 miles from London Bridge.

The iron paddle steamer Castalia joined them in 1884.  Built in 1874 by Thames Ironworks for the English Channel Steamship Co., she had been intended to run between Dover and Calais.  Designed with a double-hull to prevent rolling and therefore sea-sickness, she had proved unsuitable and had since been moored at Galleons Reach.  The owners sold her to MAB in 1883, who refitted her as a hospital ship.  Both engines and paddle wheels were removed and the space decked over.  The lower deck was divided into five wards for 84 female patients.  Five ward blocks for another 70 female patients were built on her upper deck, giving the Castalia the appearance of a floating row of houses.  The blocks were placed obliquely so as to catch more light and air.

The three ships were moored in a line, with the Endymion in the centre, about 50 metres from the shore, but not connected to it.  They were connected to each other by a complicated gangway which allowed for the rise and fall of the tide and for slight sideways movement of the vessels.

The Atlas contained the wards for male patients and even had a chapel on deck, which was used for overflow patients during epidemics.  The ship could house up to 200 beds using the main, lower and orlop decks, with isolation wards on the upper deck.  New admissions were delivered to the reception rooms on the orlop deck and then taken by a lift to the upper deck.  Also on board were the dispensary and sleeping quarters for the medical staff.  Conditions were very cramped; the only windows were the former gun ports and the ceilings were very low.

The Endymion, as well as being the administrative centre, had a kitchen on the main deck where all the food for the hospital ships was prepared.  The mess rooms for the staff were on the deck below, as were the storerooms.  Living quarters for the Matron, the steward, the male staff and some female staff were also on board.  Before leaving the ships, the staff bathed, washed their hair and changed their clothes completely.  All the ships were heated by steam generated in the hold of the Endymion, connected to the other two by flexible piping (each ship had its own boiler as a reserve, but there were no heating stoves).

The Long Reach pier was built to connect the ships to the few service buildings on land.  Some of these provided sleeping accommodation, bathrooms and dressing rooms for the nurses and female attendants.  The site also contained a laundry and storerooms.  A mortuary was built nearby, as well as stables for the horses used to transfer convalescing patients to Darenth Camp, an hour's drive away.  There were also a garden and a recreation ground.

In 1886 a shed was built to house the engines and dynamos needed for electric lighting.  The Electric Lighting Act, 1882, permitted the setting up of supply systems by persons, companies and local authorities, and MAB installed electricity on the Atlas (a fire on the Training Ship Goliath in 1875 had been caused by lighting oil lamps).

In 1893 MAB had decided to build a land-based smallpox hospital at Long Reach, but the project was delayed.  Building work finally began in 1901, just as another smallpox epidemic erupted in London.

By this time the ships were in poor condition and were proving costly to maintain.  They were dangerous, being prone to fire despite being lit by electricity, and were vulnerable to weather hazards as well as collisions with other ships (in 1898 the Castalia was hit by SS Barrowmore, an immigrant ship).  It was  difficult to restrain delirious smallpox patients from throwing themselves overboard.  It was also impossible to increase the number of patients the ships could accommodate.

The smallpox ships became redundant in 1903 when Joyce Green and the other River Hospitals began to open.  The ships had held 300 patients, therefore a fivefold increase in service was expected for smallpox patients (although a major epidemic never occurred again in London).  They had given 20 years of service and accommodated over 20,000 smallpox victims.

The ships were auctioned off for scrap in 1904.  The Atlas realized £3,725, the Endymion £3,200 and the Castalia £1,120.

In a perhaps unusual act of near-sightedness by MAB, the electricity apparatus was also scrapped and Joyce Green Hospital remained lit by gas until 1922.

Next subsection: River Ambulance Service

Next section:  Tuberculosis sanatoria

Previous section: The Metropolitan Asylums Board
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Burne JC 1973 The Long Reach hospital ships and Miss Willis.  Proceedings of the Royal Society of Medicine 66, 1017-1021.

Burne J 1999 Peace and war at Joyce Green Hospital 1914-1948.  Bygone Kent 24, 197-205.

Burne J 1999 Smallpox afloat on Long Reach 1893.  Bygone Kent 25, 275-282.



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