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In 1930, following the abolition of the Board of Guardians, it was taken over by Essex County Council as a public assistance institution for the elderly chronically sick. In 1936 it was proposed to extend the Hospital to 250 beds.

At the outbreak of WW2 the Hospital joined the Emergency Medical Service (EMS) with 226 beds, under the control of the London Hospital.

In 1917 the Orsett Union workhouse, built in 1837, became the Orsett Lodge Hospital after the Essex Vagrancy Committee ordered that only sick paupers be admitted.

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