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for some years past, moreover, have exceeded the deaths from
scarlet fever. In 1891 they were considerably more than
double as many. In 1892, the deaths were 1,885, the highest
number on record; 711 more than the deaths from scarlet
fever, and 712 above the corrected decennial average. The
admissions to hospital, moreover,are becoming morenumerous :
722, 942, and 1,312, in 1889,1890 and 1891,respectively, they were
2,349* in 1892. It is manifest, therefore, that a considerable
number of beds will have to be set aside for these diseases,
as well as a small number for typhus and ill-defined forms of
fever—the average number of deaths from which in the ten
years, 1882-91, was 89—and for isolation purposes. On the
whole, then, I am of opinion that provision should be made
of not less than five thousand beds for Scarlet Fever, "Fever,"
and Diphtheria, and Isolation.
As regards Small-pox the state of affairs presents a more
hopeful outlook. There has been no epidemic since 1885,
when the deaths in London from this disease were 1,419, and
the admissions to the Asylums Board Hospitals 6,146—
numbers which pale in presence of the fearful totals of 1871,
when the Hospitals received upwards of 13,000 cases, and the
deaths in London fell little short of 8,000. In happy contrast
with this state of things, the experience of the last seven years,
1886-92, may be cited, the total admissions having been only 613,
(306 of them in 1892), and the deaths 97. We might reasonably
hope for a continuance of this immunity—provided the
Vaccination Laws were efficiently administered—as a result
of compulsory notification, which has worked admirably, and
was the means of preserving London from an epidemic last
year. The practice of removing the sick out of London,
carried out of late years, in accordance with the recommendation
I made in 1881, has also been attended with the best
results, and still further encourages the belief that London
* Of this number only 2,019 cases, apparently, proved, under observation, to be
of a diphtheritic character.