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deaths), 1873 (113 deaths), 1883 (136 deaths), and 1886 (24
deaths). The mean annual mortality from this disease in the
deeennium, 1878-87, was 0*21 per 1,000, and lower than in any
previous deeennium. The Registrar-General, 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 Registrar-General stated
that " an examination of the successive rates shows that the
increase in the difference between the London and the provincial
rates dates from a long time anterior to the opening of the
hospitals, and, if successive decennia be compared with their
immediate predecessors, was indeed greater in the deeennium
1861-70, which preceded the opening of these hospitals, than in
1871-80, the deeennium which followed it. . . . Whatever,
therefore, may be the cause why London does not improve in
its relation to small pox to the same extent a.s 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 during the
last three years 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 was initiated upon my recommendation made
to the Asylums Board and the Local Government Board in 1881.
MEASLES.
The deaths from this disease in 1888 were 124 (11
of them in Brompton), being 40 above the corrected
c