View report page

25
lutely—than in any year since the present system of civil
registration began; the years which most nearly approached
this minimum being 1875 (46 deaths), 1874 (57 deaths), 1873
(113 deaths), 1883 (136 deaths), and 1886 (24 deaths). The
mean annual mortality from this disease in the seven years as
yet elapsed of the current decennium was 0.20 per 1,000, and
lower than in any previous decennium. The RegistrarGeneral,
in his Annual Summary for 1886,stated that London, "in
spite of the disadvantage it suffers from its perpetually shifting
population, and its comparative neglect of vaccination, has
improved its position in regard to small-pox among the great
towns since 1861-70. But the case is otherwise if London be
compared with the aggregate provinces—i.e., the whole of
England and Wales without London itself—for while the provincial
rate has fallen very greatly, the London rate has lagged
behind, so that the difference has become wider and wider." It
having been suggested that this may be attributable to the
opening of the Metropolitan Hospitals in 1871, the RegistrarGeneral
states that " an examination of the successive rates
shows that the increase in the difference between the London
and the provincial rates dates from a time long anterior to the
opening of the hospitals, and, if successive decennia be compared
with their immediate predecessors, was indeed greater
in the decennium 1861-70, which preceded the opening of
these hospitals, than in 1871-80, the decennium which followed
it. . . Whatever, therefore, may be the cause why
London does not improve in its relation to small-pox to the
same extent as the provinces, it is something that came into
operation long before the hospitals were opened." Granting this,
I have no doubt that the diminution in small-pox mortality in
the Metropolis, last year and in 1886, was largely due to the
perfected system of removing the sick direct from their homes
to the Ship Hospitals, situated, as these are, outside the London
Registration District—a system which, as your Vestry are
aware, was initiated upon my recommendation made to the
Asylums Board and the Local Government Board in 1881,
c