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the other districts of the same group. There was, indeed, but one
exception to this general statement, namely, Lambeth, where, in spite of
the presence of Stockwell Hospital, the rate was lower than in either of
the Southwark districts. Secondly, it would appear that the local
distribution of small-pox mortality cannot be explained entirely on this
basis, seeing that the group of districts, viz., the eastern, in which the
mortality was by far the highest, was one in which there was no hospital
at all.
"It may indeed very possibly be the case that though, within the limits of a
given group of districts, the district which contains the small-pox
hospital may be the one which derives on the whole, least benefit from it,
or rather which has the benefit conferred by it counterbalanced by some
small disadvantage; yet the absence of a hospital altogether from a group
of districts may be a still greater evil, by leading to a comparative
inability or disinclination to make use of a hospital situated at a distance.
According to this view that group of districts would be the worst off
that neither had a hospital of its own nor access to a hospital outside its
limits, or which, owing to distance or other reason, made comparatively
little use of such hospital; the group best off would be that which had
no hospital of its own, but made free use of hospitals outside its limits;
while intermediate to these extremes would be those groups of districts
which had hospitals within their boundaries and made use of them. A
comparison of the different groups of districts with each other, in respect
of the degree in which they severally avail themselves of the public
hospitals, confirms this view. The group with the lowest small-pox
death-rate is the one which contains no hospital, but sends the
largest proportion of its cases to hospitals outside its limits. The
group with the highest small-pox death rate is that which has no
hospital within its limits and makes less use than any other of the
hospitals outside its limits. The other groups are intermediate to these.
These facts are shown in the following table, in which the proportion of
fatal cases of small-pox that occurred in and that occurred out of public
hospitals in each group of districts is given, the death-rate from smallpox
being added for comparison.