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average number (413), and the number corrected for increase of
population (533). The zymotic death.rate, I may add, which
in 1859.70 was 3.6 per 1,000 persons living, fell to 2.8 per 1,000
in 1871.82; the deaths from these diseases, moreover, which in
1859.70 were 18 per cent. of total deaths, were only 15.4 per
cent. in 1871.82.
Other causes doubtless, besides notification, contributed to
bring about this satisfactory result, and we must not forget, as
regards enteric fever, that this disease, under improved sanitary
arrangements, has “continuously and notably declined in England
during recent years.“Chief among these causes, and one, in
my judgment, even superior in efficacy to notification, is the
provision of hospital accommodation by the Asylums Board,
under the Metropolitan Poor Act, 1867. So highly, in fact, do
I value this provision, that were I offered a choice between
hospitals and notification, I should unhesitatingly choose the
hospitals, for this reason, among others, that I am certain provision
of hospital accommodation leads, almost inevitably, to
notification; whereas, judging from the experience of certain
towns, compulsory notification has comparatively little value if
hospital accommodation be not provided.
Ambulance Service.—It will be remembered that power was
conferred on the Asylums Board by Section 16 of the Poor Law
Act, 1879, to provide ambulances for the conveyance of the
infectious sick to their hospitals, and that the Managers exercised
this power by establishing an ambulance station near London
Fields. This establishment, however, they will shortly be compelled
to abandon as a result of proceedings at law. The Hospitals
Commission, in their “Practical Recommendations," strongly
urged “that the hospital authorities should have the entire control
of the ambulances, by which all other modes of conveyance should
be as far as possible superseded and the Managers lost no time
in taking measures to give effect to this recommendation, which
is strictly accordant with the intentions of the Legislature, and,
1 may add, with the views of the Local Government Board. It