A brief history of healthcare provision in London


Following publication in 1882 of the Royal Commission report on smallpox and fever hospitals, the Metropolitan Asylums Board (MAB) began to establish a River Ambulance Service so that patients could be transported from central London to its smallpox hospital ships moored at Long Reach. (A Land Ambulance Service had been established in 1881.)

In 1883 work began on building wharves at Rotherhithe, Blackwall and Fulham, to which the patients would be brought before being taken onto the ambulance steamers.  Each wharf would have an examination room, an isolation ward for patients too ill to undergo a journey, and a ward for cases of questionable smallpox.

Before the wharves could be completed, another smallpox epidemic began in 1884, when there was only one ambulance steamer available - the Red Cross - which had been specially built for MAB.  The wards were in the fore cabin, divided by a bulkhead into two equal parts; each had 8 beds for acute adult patients.  The after cabin was used for mild cases who did not need to lie down. The Red Cross was brought into service in February, using the Potter's Ferry Wharf until the nearby North Wharf was completed.  

The Albert Victor had been purchased in May from the liquidated London Steamboat Co. for £3,150 (she was later sold in 1931 for £92 10s).  She was fitted out as a hospital, with 16-bedded wards fore and aft, but was eventually mainly used to return recovering patients to London.

A second dedicated ambulance steamer, the Maltese Cross, constructed for MAB after the Red Cross and to an improved design (following the experience gained with the Red Cross), sailed at the end of October, 1884.  She had two wards, fore and aft, each containing 16 beds for acute adult patients.

A steam launch, the Marguerite, was also acquired in 1884.  She was used for transporting visitors and the ships' staff, but was sold in 1889 as unsuitable for service.

Between 1884 and 1887 over 11,000 acutely ill smallpox patients had been transferred to the Long Reach ships by river ambulance, while 10,328 patients had been brought back.

Year Patients using the RAS
1884 5592
1885 5468
1886 130
1887 54

In March 1885, a local resident, Miss Willis, died suddenly after dancing at a ball in Erith with a porter from the Hospital ships.  Her cause of death, noted by a local doctor as 'malignant smallpox' (she had died of haemorrhage within three hours of onset) was contested by the ships' physician, who also asserted that the crew followed a strict protocol of precautionary measures when leaving their duties.  The diagnosis was never confirmed but, following this incident, MAB introduced a policy that the ships would receive supplies through the River Ambulance Service rather than be purchased locally or sent by rail.

The paddle steamers were often out of commision.  Collisions between them (their protruding paddles were particularly vulnerable) and the wharves and other vessels were frequent.  On 31st December 1888 the steamship River Derwent of Glasgow, after having sunk a vessel just below the Blackwall Reach, fouled the hulk Benmore and the Maltese Cross secured alongside, slightly damaging the latter.  The forward bitts (pair of posts for fastening cables) were torn away and the after bitts damaged.

In 1892 there was another smallpox epidemic.  By this time MAB also owned the Swallow, a steam pinnace.  The Geneva Cross, a new purpose-built ambulance steamer built in 1894, necessitated the replacement of the hulk Benmore by mooring dolphins.  At her stern the Geneva Cross had an upper cabin with two compartments for 16 acute patients and a lower cabin with two compartment for 36 patients.  Visitors could travel in a fore cabin.

In 1896 a new ambulance steam launch, the White Cross, replaced the Swallow.  The Red Cross was sold in 1897 for £450 and the money put towards the cost of the White Cross.

By 1898 the River Ambulance Service had three ambulance steamboats - the Maltese Cross, the Albert Victor and the Geneva Cross - and the ambulance steam launch, the White Cross.  In that year the Service carried 955 passengers (compared with 1293 in 1897); these comprised 6 patients (69 in 1897), 5 recovered patients (55 in 1897) and 944 visitors, staff and workmen (1159 in 1897).

During the next smallpox epidemic of 1901, MAB began to build a permanent land-based smallpox hospital.  Two temporary hospitals - the Long Reach Hospital (with 300 beds) and the Orchard Hospital (800 beds) - were built during this time and opened at the beginning of 1902.  In the same year another vessel, the Red Cross II, had been bought from the London and South Western Railway.  Originally named the Solent, she had been built as a 300-seat passenger vessel.  She was converted to hold 68 beds.

The hospital ships remained in use until the Joyce Green Hospital (with 940 beds) was completed in 1903.  The River Ambulance Service continued, with patients disembarking at Long Reach pier, then being being transported by horse-drawn ambulance (later horse-drawn tram cars) to hospital.  

During 1925-1926 the running costs of the River Ambulance Service were £7,547.

In 1930 the LCC took over control of the Service from MAB.  In July a vessel collided with the Albert Victor and a mooring dolphin at South Wharf.  After this incident, patients (some 200 a month) were transported by land ambulance rather than via the river to Long Reach.

The River Ambulance Service terminated in 1933.  In February and March the steamers left South Wharf for mooring at Erith, prior to disposal, following disinfection and certification by the Port Sanitary Authority.
Smallpox epidemics in London
1870 - 1872
1876 - 1878
1881 - 1882
1884 - 1885
1893 - 1894
1901 - 1902

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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.

Wilson N 1995/6 Ship Ahoy!  Metropolitan Asylums Board River Ambulance Service.  Unpublished dissertation filed at the Wellcome Library.


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