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of home-patients were spreading the disease, and the President's chief anxiety was to be advised
—How the "hospital question, which," he said, "underlay the whole of the subjects brought
to his notice," was to be dealt with ? Then it was that I made the recommendation for removal
of the sick to hospitals without London, which, carried into effect within a few days, mid
perfected bv the Asylums Board in 1885, has had such remarkable results in reduction of smallpox
prevalence and mortality. But for notification London had yet to wait eight years. In
1887 the Vestry initiated a further attempt to procure notification by legislation, by an appeal
to the Local Government Board, which was supported by sanitary authorities, the Asylums
Board, the Society of Medical Officers of Health, the Association of Municipal Corporations, etc.
The Vestry's communication was simply acknowledged, and as it seemed that the effort was
not likely to have the desired result, the Vestry, at my suggestion, resolved to institute a system
of paid voluntary notification. This was carried into execution forthwith, and proved very
successful. Medical practitioners were at the same time invited to make direct application to
the Asylums Board for the removal of their patients, upon their own certificates, a service for
which they were paid an additional fee, and expenses out of pocket, for telegrams, etc. At this
time the Asylums Board were admitting patients upon the application of medical men whose
certificates they had long since accepted, although it was not until this year (1887) that the
Local Government Board, by an Order, authorised the admittance of patients upon such
certificates. The system of removal of patients to hospital by private practitioners, upon their
own certificates, has been in operation ever since in this parish, with incalculable advantage to
the sick and the public.* But to resume. The Local Government Board, at the end of 1887,
instituted an inquiry in towns where compulsory notification was in force, with results entirely
satisfactory; and in 1888 the President announced at Sheffield, where small.pox was rampant,
his intention to bring in a Bill, and he did so in 1889. The Act passed with practical unanimity.
Compulsory for the Metropolis alone, it was made adoptive for the rest of England and "Wales,
and by request of the Irish members was extended to the sister island. From the first it proved
a success, and when, in 1899, notification was made universally compulsory by the Infectious
Disease (Notification) Extension Act, only a small residuum of the sanitary authorities remained
to be coerced.
Results of Compulsory Notif cation and Provision of Hospital Accommodation.—Whilst it
would be wrong to ignore the beneficial effect upon public health, qua infectious disease, arising
from improved sanitary administration, consequent upon the creation of the vestries, etc., in
1856; provision of hospitals, since 1870, and compulsory notification, since 1889, must be
credited with the largest share in the remarkable reduction in mortality signalising the last
thirty, and particularly the last ten years. The two systems may be regarded as complementary.
Singly, I attach the greater value to hospitals, for means of isolation leads to disclosure of
sickness, whilst without hospitals, notification would be of minor usefulness For hospitals and
notification alike, we are largely indebted to the terror inspired by small.pox, and it is in
respect to this loathsome disease that their combined effect has been most manifest, as the
following figures eloquently testify: —
It thus appears that in the fifteen years 1871.85, during which small.pox was treated in London
—wholly until nearly the middle of 1881, and partly thenceforth until the middle of 1885—the
deaths from this cause were 21,118; whereas in the fifteen years 1886.1900, during which
patients have been treated out of London, the deaths were only 477. The comparison between
the first quinquennial period (1871.75) and the last (1896.1900) is very striking. Suffice it to
say that if the deaths in the last five years had been as numerous, in proportion to population, as
in the first five years, not 33 persons, but 14,131 persons would have died from this disease in
London, including 244 in Kensington, in which district there was not one death from this cause.
Very striking, too, has been the reduction in scarlet fever mortality. In 1900 the deaths
in London from this cause were 361; in 1870 they were 6,040. In the quinquennium 1896.
1900, the deaths were 3,039: had they been as numerous, in proportion to population, as in the
five years, 1866-70, preceding the hospital regime, more than 26,000 persons would have died.
The reduction in "fever" mortality is also eminently satisfactory; for during the five years
1896-1900 only 3,363 persons died from the diseases grouped under this heading, the calculated
mortality, on the scale of the years 1866-70, after correction for increase of population, being
16,918. Typhus, which in the first year of its separate classification (1871) was accountable for
716 deaths, has become an almost extinct disease, having been the registered cause of only 61
* For example : In ordinary circumstances a notification male on Saturday does not reach the office until Monday.
Very generally the sick person in such a case is admitted to hospital on Saturday on the notifying practitioner's application :
about forty.eight hours before he would have been admitted on an application from the office made on Monday.