\ With Dr. Robkrt Fowler's Compliments?^ 
 
 %\t ^T^tr0|joIita:M ^sgtoiws gislrkt §0ar!bf. 
 
 SPEECH 
 
 OF 
 
 ROBERT FOWLER. M.D., 
 
 On TUESDAY, Nov. 9, 1881, 
 
 AT MEETING OF 
 
 CITY OF LONDON UNION GUARDIANS. 
 
 LONDON: 
 PRINTED BY WATERLOW & SONS Limited, LONDON WALL. 
 
 I S 8 2.
 
 After seven weeks' discussion, the following motion, 
 proposed by Mr. Sly and seconded by Mr. Judd, was 
 adopted {nem, con.) by the City of London Union 
 Guardians on December 13, 1 88 1 : — 
 
 "Considering that the Metropohtan Asylums District Board has 
 called upon the ratepayers of the Metropolis for ;^24o,ooo for this 
 half-year, of which £22^700 falls upon the City of London, this Board 
 is of opinion that the time has now arrived when a Parliamentary 
 Commission should be appointed to inquire into the working of the 
 Acts under which the Metropolitan Asylums District Board was 
 formed ; and further to inquire and report fully upon the manage- 
 ment, expenditure, and results in respect to the establishments under 
 its control."— C//y Press, Dec. 14, 1881.
 
 il|e ^firopoliian gisnlmra §\^t\[ld gonrl 
 
 SPEECH 
 
 OF 
 
 ROBERT FOWLER, M.D, 
 
 OjV TUESDAY, NOV. 9, j8Si, 
 AT MEETING OF CITY OF LONDON UNION GUARDIANS. 
 
 Mr. Chairman : Some years ago I was engaged, as 
 has similarly been Mr. Sly of late, in poring over for 
 hours, days and weeks Parliamentary Blue Books whence 
 to cull matter for the subject I was then working at. 
 
 I can, therefore, truly sympathise with the labour which 
 Mr. Sly has evidently for some time past imposed upon 
 himself. 
 
 In all candour, also, I must say that from a ratepayer's 
 point of view he has, perhaps, made as fair a summary of 
 facts and figures as would be acceptable in the present 
 mood of the public mind. 
 
 Whether, however, from a natural reticence or whether 
 from a pardonable ignorance he has not, I think, sufficiently 
 told us of the grave causes which led up to the formation 
 of the Asylums District Board. I do not hesitate to 
 begin my observations by supplying this deficiency. I do 
 so with the more confidence because — first, as is well known 
 to not a few around me, I myself took no small part in iJie 
 agitation which eventually led up to the passing of Hardy's 
 Act ; secondly, because, as Mr. Sly himself casually observed, 
 the Infirmary of the old City of London Union pre per, 
 then as now in the Bow Road, was the one institution of 
 the sort which stood out blameless and scatheless during 
 the investigations he alluded to. The management of the 
 sick poor of this one Union was, generally speaking.
 
 excellent. Without going into details which would be 
 annoying, as they are now unnecessary, I would simply 
 state that the medical treatment of the sick poor in general 
 was under the old regime (to say the very least) most 
 unsatisfactory. 
 
 It was not only however in 1866 that this fact was first 
 recognised. Soon after the passing of the- Poor Law 
 Amendment Act of 1834, the poor law medical staff began 
 constantly, but without avail, to bring the matter to the 
 notice of the public. The doctors were invariably met 
 by the insinuation that they were simply agitating for an in- 
 crease of their miser able salaries,and they were always taunted 
 with this silly argument — v/hich is as applicable to the 
 office of a Lord Chancellor or of an Archbishop — that if they 
 resigned there were always plenty of applicants for their 
 posts and perhaps at less salaries. 
 
 At length, sir, the straw came which broke this wretched 
 camel's back. Certain cases occurred in some of the 
 metropolitan workhouses, notably the Timothy Daly case 
 in an adjoining union, which caused a great social 
 scandal. 
 
 Besides the investigations undertaken by one of the 
 medical journals, private and influential members of the 
 general public commenced a serious inquiry into the treat- 
 ment of the sick poor. Members of the City Corporation, 
 members of parliament, and the clergy, headed, if I 
 remember aright, by an Archbishop, took active part in the 
 movement. At length such pressure was put upon the 
 Government of the day (and mind you, sir, a strong 
 Conservative Government not given, it is said, to takeaway 
 ancient privileges) that the Legislature, despite vigorous 
 opposition from the Boards of Guardians, passed Hardy's 
 Act. The City of London Union was not strong enough 
 to have its excellent management excluded from the 
 operation of this Act. 
 
 Now, sir, what did Hardy's Act mean ? It implied in so 
 many words, and in language analogous to that made use 
 of by Mr. Sly towards the action of the Asylums Board, 
 that the treatment of the sick poor under the old regime 
 was in general a miserable failure, and that it must be 
 reformed altogether. Now, what has the Act done for 
 this metropolis ? By one stroke — first, it took away from 
 the control of Boards of Guardians the care and treatment 
 of all sick poor suffering from any form of infectious 
 
 ■5 
 
 uiuc![
 
 5 
 
 diseases ; secondly, it took away from the control of Boards 
 of Guardians the care and treatment of the pauper-born 
 idiot ; thirdly, it took away from the control of Boards of 
 Guardians the care and treatment of the adult imbeciles ; 
 fourthly, it empowered the Local Government Board to 
 appoint nominees of its own on the Committee of Manage- 
 ment of the Union Infirmary. I need not tell you that this 
 last power has not yet been exercised at our own Infirmary, 
 but it has in certain of the Metropolitan Unions ; fifthly, 
 when I add that virtually, also, the power to control the 
 education of the pauper children has been taken away 
 from Boards of Guardians, one cannot but reflect that the 
 necessity must have been very urgent to have required 
 such a radical alteration in the powers of Boards, which, 
 for thirty years had had unlimited care and control over the 
 whole pauper population. 
 
 Practically, at present we have but a strictly definedxare 
 and control over that most worthless scum of humanity — 
 the able-bodied pauper — and overtheaged poor who happen 
 not to be sick. 
 
 Mr. Sly has made some very pertinent observations, with 
 which I quite agree, and would even go furth^j:- On the 
 principle that representation and taxation should go to- 
 gether, Mr. Sly is of opinion that the Local Government 
 Board should contribute towards the support of that Board 
 on which it has fifteen nominees. 
 
 I should like to see the total expense of pauperism 
 be an imperial or national, and not a more or less local 
 charge. 
 
 Whilst studying the operation of the Poor Law, I soon 
 discovered that the one thing needed under the old regime 
 was the equalization of the poor rates. 
 
 This, I need not tell you has been partly effected in this 
 metropolis, not only by the establishment of the Metro- 
 politan Common Poor Fund, but also by the amalgamation 
 of certain of the unions. 
 
 Now, sir, although I was one of the chief victims, I do 
 not hesitate to say that the amalgamation of the three City 
 Unions was of inestimable value both to the poor and to 
 the ratepayers of the old East and West London Unions. 
 So also, it is my opinion, that the passing of Hardy's Act 
 has been and will be of inestimable value to the sick poor 
 of the whole metropolis. 
 
 Such a radical reform as this Act effected — such a novel
 
 experiment in poor law administration — could not possibly 
 have been carried out without some mistakes and without 
 great expenditure. 
 
 These two complaints, when added to the statement of 
 inefficiency, are substantially the whole of the charges 
 brought against the Asylums Board by Mr. Sly. 
 
 As regards the mistakes, not only is the Asylums Board 
 answerable, but the Boards of Guardians are not blameless 
 in the matter. 
 
 The mistakes made were due mainly to the want of 
 precise knowledge on the part of science about infectious 
 diseases. Science really did not know what it now knows 
 respecting the power and fertility of the infective matters 
 which cause these diseases. 
 
 Consequently the extrem.e precautions which are now 
 taken by the Board for the safety of the public (and which 
 incidentally I may remark add of course to the expenditure) 
 were not in by-gone days considered necessary. I venture 
 to assert that if the Hamp?tead Hospital case were tried 
 to-day, the plaintiffs would find a very great difficulty 
 indeed in proving their case on its medical merits. 
 
 I hold in my hand a printed copy of the final judgment 
 of the House of Lords on the appeal in reference to the 
 point of law.' 
 
 Lord Blackburn, in his speech, said : — 
 
 *' The case came on for trial before Baron Pollock, when it was agreed 
 that the amount of damages should be referred. He asked the jury 
 five questions, which with their answers were as follows : — 
 
 (ist.) Was the hospital a nuisance occasioning damage to the 
 plaintiffs or either, and which of them jz^^r se f (2nd.) Or by reason of 
 the patients coming to and going from the hospital } Answers ist 
 and 2nd : It was a nuisance to each cf the plaintiffs per se, and by 
 reason of the patients coming to and going from the hospital. (3rd.) 
 Assuming that the defendants -were by law entitled to erect and carry 
 on an hospital, did they do so wirh all proper and reasonable care 
 and skill with reference to the plaintiffs' rights } A. : No. (4th.) 
 Assuming that the defendants were by law entitled to erect and carry 
 on this hospital, did they do so with proper and reasonable care and 
 skill with reference to the plaintiffs' rights } A. : No. (5th.) Did the 
 defendants use proper care and skill with reference to ambulances ? 
 A. : No ; we consider the ambulances ought to have been disinfected 
 before leaving the hospital." 
 
 Now I take this opportunity of emphatically repeating 
 what was contradicted last Tuesday, that althotngh a Mid- 
 dlesex jury have found that the hospital was a nuisance /ifr
 
 se, this opinion has not been confirmed by the highest legal 
 tribunal in the land. That appeal is still pending before 
 the House of Lords, 
 
 For part of the mistakes attached to this verdict of the 
 jury, the Boards of Guardians are clearly to blame. I 
 mean in the matter of the ambulances which were not then 
 under the control of the Asylums Board. Every precau- 
 tion is now taken to prevent drivers of the Asylum Board's 
 ambulances stopping at public-houses, children riding 
 behind, and friends, and too many cases, perhaps, of diffe- 
 rent diseases, riding together in, the vehicles. I could, 
 were there time, detail many dangerous neglects on the 
 part of ambulances now belonging to Boards of Guardians ; 
 and I must say this Board has made a mistake in not 
 acceding to the use of the admirably conducted ambulance 
 station at the London Fields. Whether or not this Board 
 uses its own ambulance, it will also in the future incur the 
 expense of contributing to the ambulances of the Asylums 
 Board. 
 
 By the Poor Law Act, 1879 (Vict., Ch. 42 and 43, sec. 16) 
 the managers are empowered " to provide and maintain 
 carriages suitable for the conveyance of persons, suffering 
 from any dangerous infectious disease." 
 
 As regards the great expenditure of the Asylums Board, 
 I shall leave my more commercial colleagues to attack, if 
 they deem it necessary, Mr. Sl})'s figures in detail. I 
 would simply observe, first, not a farthing of these large 
 sums is ever expended by the Asylums Board without 
 obtaining the previous sanction of the Local Government 
 Board ; secondly, it is the ratepayers' own fault if they do 
 not take exception to these items at a time when their 
 exception might avail. Ample provision is made for this 
 privilege by the several rules laid down respecting the 
 audit of the accounts. By order of the Poor Law Board, dated 
 November 8th, 1870, the Clerk to the Board of Management 
 is at once (Art. 19) to notify to the Guardians the day 
 appointed for the audit of the accounts, and *' a copy (of 
 such notice is) to be hung up in some conspicuous place in 
 their Board-room, and shall continue the same so affixed 
 and hung up until the audit is completed." By Art. 20 — 
 
 " The said half-yearly statements of JJthe managers, together with 
 the ledgers (are to be deposited) in the Board-room of the managers, 
 or such other place as the Board of Management may appoint, and 
 .... the said statements and ledgers (shall) be inspected, examined 
 and copied by any ratepayer or owner of property in the district."
 
 Art. 33 says — 
 
 " The auditor shall receive any objection made by a ratepayer or any 
 person aggrieved against the accounts undergoing audit, or any item or 
 charge therein, or any vouchers or authority for the same, and shall 
 examine into the merits of such objection and make a decision re- 
 specting the same, stating the grounds thereof, and offering to enter 
 the same in the book of account then being examined, if required 
 to do so, as in the case of a disallowance or surcharge.' 
 
 ** If the Auditor find that any money, goods, or chattels 
 belonging to the Board of Management have been pur- 
 loined, embezzled, wasted, or misapplied," report of such 
 is to be made (Art. 35) by him to Board of Management. 
 Furthermore, in his certificate, forwarded after each audit 
 to the Local Government Board, the Auditor has (Art. 36) 
 to " certify that the entries appear to be correct and legal." 
 
 I am officially informed that only one ratepayer of 
 London has ever availed himself of the powers and privi- 
 leges secured by these several articles, and the result was 
 that he once succeeded in inducing the Auditor to surcharge 
 the committees for refreshments supplied them when in 
 attendance at the infectious hospitals. The Local Govern- 
 ment Board at once disallowed the surcharge. They 
 recognised the inconsistency of the managers advising 
 visitors to patients partaking of a good meal before entering 
 these wards, whilst the committee, who risked their healths 
 and lives in the performance of their duties, were to be 
 deprived of the same precautions. 
 
 The great expenditure of the Asylums Board has, in my 
 opinion, been brought about by more causes than one. 
 1 hese causes are : — 
 
 First, and perhaps mainly, these bodily and mental 
 maladies of the poor are now treated according to the 
 dictates and demands of science and of humanity. Speak- 
 ing as a medical man I have no hesitation in expressing 
 my opinion that these demands h roe not been over :^tLpplied. 
 
 Secondly, the selfish opposition of the ratepayers them- 
 selves has not a little added to the expense. 
 
 Thirdly, so also has the neglect of their legal duties by 
 the various Sanitary Authorities of the Metropolis, aided, 
 as I must say this has been, by the unfriendly antagonism 
 of Boards of Guardians. 
 
 I have used mild language in speaking of the general 
 treatment of the sick poor under the old regime. Of 
 the treatment of the poor afflicted with these terrible
 
 9 
 
 maladies, now under the care and provision of the Asylums 
 Board, I will say that before the passing of Hardy's Act it 
 was a complete farce. The doctors were expected to make 
 bricks without straw. The poison which produces these 
 infectious diseases cannot be controlled by any drug yet 
 known to the science of medicine. Skilled nursing and 
 appropriate diet are the only remedies to carry the patient 
 through his disease. Yet these were the very points on 
 which there used to be constant collisions between the 
 medical officers and the relieving officers, who were some- 
 times, I am sorry to add, supported by the Boards of 
 Guardians. 
 
 Now the Medical Superintendent is supreme and practi- 
 cally omnipotent. His drug bill is virtually nil, whilst 
 ice, medical comforts, stimulants, and night and day skilled 
 nurses have to be provided for ad libitiLin. It would have 
 been a subject worthy of Hogarth's brush to have painted 
 the face of a relieving officer had the medical officer under 
 the old regime have ordered iced champagne for a pauper 
 fever patient. From sad experience I must, however, say 
 that even when the medical officer obtained all these 
 requisites it was a most thankless and helpless task to 
 treat fever, small-pox, or cholera amidst all the insanitary 
 surroundings of the sad dwellings of the poor. 
 
 To ^\.Y^ you an instance of the present supreme power 
 of the Medical Superintendent^ I will just relate that at one 
 of the infectious hospitals it was found the cost of daily 
 maintenance during the past half-year was just double 
 what it was at another. In explanation it was ascertained 
 that at the former the Medical Superintendent had more 
 rigorously interpreted the following order of the Local 
 Government Board, and had destroyed the clothing of 
 every pauper on his admission, necessitating, of course, the 
 supply of new clothing on his departure : — 
 
 "The clothes worn by the pauper at the time of his admission shall 
 be forthwith disinfected, or otherwise dealt with as may be directed by 
 the Medical Superintendent, who, where the clothes are destroyed, shall 
 keep a record of the fact." (Ordered loth February, 1879, Article 9.) 
 
 So also with the idiot and the imbecile. No drug can 
 produce the brain which God has not originally granted, 
 nor restore the brain which is irretrievably lost. Yet some- 
 thing may be done for the congenital idiot, as Mr. Sly 's 
 own admission conclusively proves. As I understand Mr.
 
 10 
 
 Sly, 'he rather sneeringly taunts the managers that they 
 can show only 4 per cent, of cures amongst the pauper 
 idiots in the asylum under their care. 
 
 During the six years ending 1880, during which the 
 managers have had any care or control over this class of 
 paupers, 906 idiots have been admitted to Darenth. Thus, 
 by Mr. Sly's own figures, it would appear that nearly 40 of 
 these poor creatures have been cured by the treatment 
 employed. This is a great contrast as compared with the 
 results of the so-called treatment under the old regime, 
 and I appeal to the impartiality of the press to take cog- 
 nizance of the fact. During my twenty years' medical 
 experience in the Poor Law service, in the provinces and 
 in the metropolis, I have never known a single case cured 
 under the management of Boards of Guardians. Neither 
 have I, during all that period, ever witnessed the least effort 
 by any Poor Law Authority towards that moral training or 
 that mental tuition of the pauper idiot so characteristic of 
 Darenth. 
 
 I publicly challenge the Chairman of the Lunatic Com- 
 mittee of the City of London Union to produce a single 
 statistical fact or figure (not a mere assertion) showing even 
 a portion of i percentage of cures amongst these poor 
 idiots during the thirty years the old City of London 
 Union had the charge of them. 
 
 The Guardians did not, sir, in my opinion, fulfil the 
 whole duty of humanity by simply providing for the 
 physical wants of the idiot and of encouraging the visita- 
 tion of relatives and friends, such visitations being more 
 often mischievous in result than beneficial. The Guardians 
 had full legal power to do all that the managers, guided by 
 science and humanity, have, in six years only, so ably 
 accomplished. * 
 
 Independently of the cures Mr. Sly admits, Darenth has 
 indeed done more. The uncared-for idiot, dirty and mis- 
 chievous in its habits, with its hair unkempt and perhaps 
 filled with vermin, after a few months' careful moral train- 
 ing, judicious mental tuition, good food and fresh air, 
 becomes a clean, tidy, manageable human being, capable, 
 under continuous supervision, of mechanical employment 
 as a tailor, a shoemaker, or a carpenter. 
 
 Secondly, the ratepayers themselves have by their selfish- 
 ness added considerably to the expenditure of the Asylums 
 Board. The ruling idea since 1867 seems to have been —
 
 n 
 
 put your infectious cases anywhere else but near me. If 
 you come near me I will indite you as a nuisance. Thus 
 the Asylums Board have been continuously in this dilemma : 
 they were liable on the one hand to a mandamus for not 
 removing" a case of infectious disease from a crowded 
 neighbourhood ; and so soon as they did remove the case 
 they were threatened with an action at law for creating a 
 nuisance to some individual. Had not the Hampstead and 
 Fulham cases occurred, practically depriving the managers 
 of at least 540 beds during the very height of the present 
 small-pox epidemic, and had not the several sanitary authori- 
 ties, the vestries of the metropolis, neglected those duties 
 imposed upon them by law, the Asylums Board would never 
 have been put to the great expense of fitting up the camp 
 at Darenth, or of taking over from the Admiralty the two 
 ships Atlas and Endyuiion. 
 
 Here I must digress to comment on the language used 
 last Tuesday by Mr. Bonnewell, when referring to these 
 ships. Let me tell him, sir, these ships are not two old 
 hulks, but magnificent line-of-battle ships (the Atlas was 
 never put in commission). Furthermore that the gentle- 
 man who had most to do with their initiation .is quite 
 undeserving of that silly word-play upon his name which 
 Mr. Bonnewell indulged in. Sir, such language is not 
 argument. In my opinion it merely serves, as our great 
 poet has observed — 
 
 " To suckle fools 
 And to chronicle small beer." 
 
 Monstrous assertions have been made respecting the total 
 cost of mooring and fitting up these two ships. The fact 
 is, that about ;J20,000 will cover the bill, a comparatively 
 small sum for two magnificent floating hospitals which will 
 hold as many small-pox patients as can be accommodated 
 at Homerton and Stockwell combined, which two hospitals I 
 believe I am not wrong in saying cost together over;^ 1 80,000. 
 These ships will probably belong to the Board for ever, as 
 the Admiralty is not likely ever to ask for them again. 
 There are many medical advantages in treating infectious 
 diseases on floating hospitals, upon which this, of course, is 
 not the place to dwell. 
 
 Before leaving this part of my subject I will give you 
 one typical instance showing how the selfishness of rate- 
 payers adds to the expenditure of the Asylums Board. It
 
 12 
 
 came forcibly before us at our last meeting, when the 
 Homerton Committee asked the approval of the Board 
 for what had been done in the matter. In May last the 
 Hackney Sanitary Committee, through their Medical Officer 
 of Health, addressed the President of the Local Government 
 Board, asking him to call the immediate attention of the 
 managers of the Asylums Board to the state of Homerton 
 Small-pox Hospital, especially pointing out " the following 
 [ijtier alia] as the most important works : — 
 
 1. The alterations at the entrance to the hospital. 
 
 2. The raising of the walls all around the hospital." 
 
 As regards No. i the memorial subsequently submitted to 
 the Homerton Committee stated : — 
 
 " The Committee would also point out another source of dan« er to 
 the inhabitants of the neighbourhood arising from the ambulance being 
 compelled to stop outside the gates during the time occupied by the 
 porter or his wife in coming from the lodge. During tnis interval 
 children frequently gather round the vehicles, and may thus become 
 infected. In the opinion of the Committee this should be forthwith 
 remedied by the present gates being always left open during the day, 
 and inner gates erected within the hospital grounds." 
 
 Now the structural alterations necessary to save this 
 one-twelfth of a minute " occupied by the porter or his 
 wife in coming from the lodge " will cost about £i6o. 
 
 The Sanitary Committee further suggested (No. 2) that 
 the surrounding walls "should be raised to a uniform height 
 of twelve feet at least." The said walls were about eight 
 feet in height, and the wise supposition of the Hackney 
 people that four more feet would entirely prevent a small- 
 pox germ being blown over the wall even by such a gale 
 as we had two Fridays ago, has had to be effected at a 
 further cost of ^^340. Thus the Asylums Board are on the 
 one hand called by local ratepayers to undertake these 
 puerile and expensive precautions, whilst on the other hand 
 the ratepayers of the metropolis constantly taunt the 
 managers about the really necessary expenditure which 
 they incur. 
 
 Thirdly, the neglect of the sanitary authorities to provide 
 for the care and treatment of the non-pauper population 
 afflicted with fever and small-pox, practically threw the 
 provision for these on the purse of the Asylums Board, 
 which was only legally liable for pauper patients. Boards 
 of Guardians virtually aided the Sanitary Authorities in 
 this matter and compelled the Asylums Board to occupy
 
 13 
 
 beds intended for paupers with patients certainly not of 
 that class. For example, a domestic servant at a large 
 hotel or a young shopman at a large warehouse was seized 
 with an infectious disease. Instead of isolating the case on 
 the premises, the aid of the parochial authorities is im- 
 mediately summoned, the relieving officer and the district 
 medical officer conjointly eftect the removal of the patient 
 to one of the pauper establishments. Mr. Sly alludes to 
 this fact in a very clever but, I think, very unfair way. 
 He says : — 
 
 " The Asylums Board cried for help to the very men they had super- 
 seded, and as soon as the Guardians took the matter in hand there 
 was confidence, and the disease abated." — Ci/y Press, Nov. 2, 1881, 
 p. 2. 
 
 The facts are simply these : On February 8, 1 881, the 
 Metropolitan Asylums Board sent a circular letter to the 
 various Sanitar}^ Authorities and Boards of Guardians, con- 
 taining the following words : — 
 
 " That should the number of admissions continue at the present rate 
 all the accommodation the managers have or can provide (pending the 
 decision of the House of Lords in the Hampstead Hospital case) will be 
 exhausted in about three weeks, after which it will be n^essary for 
 the various Sanitary Authorities and Boards of Guardians to supple- 
 ment the action of the Board by making provision for the accommoda- 
 tion of any additional cases of small-pox that may arise in their 
 respective districts." 
 
 On February 23, 1881, the Local Government Board, in 
 a circular to the Metropolitan Boards of Guardians, 
 observed ; — 
 
 " The Board will be glad to be informed whether the Guardians will 
 be able to make temporary arrangements for the treatment and isolation 
 of a certain number of their own cases of small-pox, and if so, of the 
 extent of the accommodation which they contemplate being able to 
 provide." 
 
 Speaking generally, the answer was in the negative from 
 the whole metropolis. This Union in so many words told 
 the Asylums Board, " it was their business to take care of 
 these infectious cases, and they must do it." What, there- 
 fore, the Guardians, who did not take the matter in hand, 
 had to do with the return of confidence or the abatement of 
 the epidemic it is very difficult for anyone, except Mr. Sly, 
 to explain. The result, however, was that in consequence 
 of the neglect of their legal duties by the Sanitary Authori-
 
 u 
 
 ties, and in consequence also of the unfriendly opposition 
 of the Boards of Guardians, the Asylums Board having prac- 
 tically no beds either at Hampstcad or at Fulham, were 
 driven at great expense to provide for the increasing 
 number of cases by establishing the convalescent camp at 
 Darenth and by furnishing and fitting out the two ships 
 Atlas and Endymion. As instances of individual neglect 
 amongst the sanitary authorities I would just allude {a) 
 to the recent outbreak of typhus in Marylebone — an 
 epidemic which should not have arisen had there been an 
 efficient house-to-house visitation of these wretched dwell- 
 ings of the poor ; * and iU) to the fact that amongst the 
 great number of cases of small-pox which have been 
 admitted into our hospitals from Hackney parish there is 
 abundant evidence of the neglect of vaccination and of re- 
 vaccination in that district. Of the 280 cases admitted 
 from Hackney parish into the Homerton Hospital during 
 1880 at least 35 per cent, were either not vaccinated or 
 were doubtfully vaccinated. 
 
 I now come to the last charge made against the Asylums 
 Board by Mr. Sly — that in a sanitary and mortality point 
 of view the action of the Board has been a miserable failure. 
 For some unaccountable reason the counsel for the Board 
 in the Hampstead case did not bring forth all the strong 
 rebutting evidence at hand against the plaintiffs' view that 
 the hospital spread the disease in the neighbourhood. 
 
 The whole medical profession is amazed at this, especi- 
 ally when such men as the late Mr. Marson, of the High- 
 gate Small-pox Hospital, and the late great fever authority, 
 Dr. Murchison, were then living and able to speak so 
 authoritatively on this matter. 
 
 Even the actual facts favouring the defendants were 
 only sparingly brought out. 
 It is an undisputed fact : — 
 
 "That the small-pox had been hanging about Hampstead and 
 Kentish Town from an early period of 1870, and that in the latter dis- 
 trict, in the month of November — the month immediately preceding 
 the opening of the hospital — there were, judging from the two deaths, 
 probably thirty or forty small-pox cases in the said district — a district 
 which is only distinct from Hampstead in name — before a single case 
 entered the Hampstead Asylum ; and, notwithstanding, it has been 
 
 * Dr. Norman Kerr says : — "The Sanitary Authority .... ought 
 to have suppressed the epidemic more than a month ago, and thus saved 
 several lives." — Letter on the Sanitary Committee of the St. Marylebone 
 Vestry. Lancet^ Nov. 12, 1881, p. 862.
 
 15 
 
 asserted that small- pox in Kentish Town and Hampstead was due to 
 the existence of the small-pox hospital." — British Medical Journal, 
 Jan. 30, 1875, p. 157. 
 
 "That the existence of the Hampstead Hospital contributed nothing 
 to the spread of small-pox may be inferred from the fact, that districts 
 without such a hospital as Hampstead suffered in greater proportion, 
 as the following figures extracted from the Registrar- General's returns 
 will show." — British Medical Jou7-nal^ ibid. 
 
 
 Population in 
 1871. 
 
 Deaths from week ending 
 July 9th, 1870, to week 
 
 Ratio per 
 
 
 ending August 3, 1870. 
 
 
 Hampstead 
 
 32,271 
 
 1,358 
 1,332 * 
 
 
 
 
 '>fi 
 
 08 
 
 St. Pancras Division 
 
 
 
 Regent's Park 
 
 38,192 
 
 48 
 
 1-27 
 
 Tottenham Court Road 
 
 39,360 
 
 48 
 
 I'22 
 
 Gray's Inn Road 
 
 29,216 
 
 50 
 
 171 
 
 Somers Town ... 
 
 38,562 
 
 137 
 
 3-56 
 
 Camden Town ... 
 
 18,066 
 
 41 
 
 2*26 
 
 Kentish Town ... 
 
 68,198 
 
 1 88 
 
 276 
 
 As evidence that infection does not radiate frgm fever 
 and small-pox hospitals, and that, as a matter of fact, the 
 hospitals which exist do not carry destruction to the 
 neighbourhood, I call attention to the following facts : — 
 
 A. — In 1 870-1. *' Bartram Lodge is the house nearest to the present 
 Hampstead Hospital, and is used as an orphanage under the superin- 
 tendence of French Catholic sisters. There are usually about fifty or 
 sixty young girls in the orphanage, besides various other persons. 
 The distance of the house itself is 107 feet from the nearest hospital 
 pavilion. Now, since the present temporary hospital was opened 
 7,352 cases of small-pox and 218 cases of relapsing fever were treated 
 in the various pavilions,but not a single case of small-poxf or of relapsing 
 fever occurred in the orphanage. It may be fairly said that all the 
 residents were vaccinated, and that in this way their exemption may 
 be explained ; but the same cannot be said for the relapsing fever, 
 which is very infectious to persons of both sexes and of all ages." 
 — British Medical Journal, Dec. 26, 1874, p» 826. 
 
 B. — " There never was an instance of typhus spreading from the 
 London Fever Hospital to neighbouring houses, even when this 
 hospital was one of a row of houses in Gray's Inn Lane, and, when 
 the hospital occupied its second site at King's Cross, on the same plot 
 
 ♦ Deducted, being deaths in Hampstead Hospital of patients sent from 
 other districts. 
 
 fTwo cases of small-pox (one a severe one) have been lately (Dec, 1881) 
 admitted to Homerton from this very Orphanage. The Hampstead 
 Small-pox Hospital was closed in June, 1879.
 
 i6 
 
 of ground as the small-pox hospital and vvithin a few yards of it. Dr. 
 Tvveedie states, that notwithstanding the certainty with which its own 
 officials contracted typhus, there had been no instance of this fever 
 among the officials of the small-pox hospital during eight year.>." — 
 Miirckison — Continued Fevers of Great Britaiiiy^^igQ 86. 
 
 C. — " One of the workhouses of the City of London Union forms the 
 west boundary of the Homerton Fever Asylum. The workhouse is 
 certified to hold about 800 inmates, yet not a single case of fever* has 
 appeared in it since the asylum was opened. Moreover, its sick 
 infirmary — which contains not only aged and infirm persons, but 
 infants, young children and puerperal women, of all persons the most 
 liable to one fever, to wit, scarlet fever — is within 20 feet [ 1 yards, 
 vide infra D.] of that pavilion of the fever asylum, which has been 
 used for scarlatina during the last three years, and not a single case 
 o\ scarlatina has occurred in the union infirmary since the Homerton 
 Asylum was opened." Dr. C. T. Aveling, medical officer of the 
 Homerton Infirmary of the City of London Union. — Britisk Medical 
 Joui-nal^ Dec. 26, 1874, p. 826. 
 
 D. — ''The infirmary of the City of London Union at Homerton 
 stands at a distance of 99 feet from the westernmost block of the 
 Homerton Fever Hospital, and in this block upon twof occasions, for 
 a period of four months each, there were 40 small-pox beds constantly 
 occupied. The windows directly face each other and are almost 
 always open. Here then, apparently, are the conditions for the pas- 
 sage of small-pox poison, if it be true that it may be carried long 
 distances through the air. Amongst a number of persons, consisting 
 of children, new-born infants, and young women in confinements, 
 there were likely to have been some susceptible subjects. The poison 
 was there, and not only in the block referred to, but in certain winds 
 it would be blown from three similar blocks which are parallel to it. 
 Thus air, liable to contamination by about 250 small-pox patients, 
 might on two different occasions, for a period of about four months, 
 have passed into rooms inhabited by persons some of whom were pro- 
 bably susceptible to its influence, and yet on neither of these occasions 
 did a single case of small-pox arise in the union infirmary {vide 
 appendix A.) ; and although scarlet fever has been treated in the 
 same block for 9 years with the small-pox exceptions referred to, no 
 single case of scarlet fever has arisen in the lying-in-wards of the 
 infirmciry or in the children's dormitories." — Transactions of the 
 Society of Medical Officers of Healthy 1H79-80, p. 78. Dr. Alex. 
 Collie, " On some public-heahh points in the management of a small- 
 pox hospital." 
 
 E. — F'rom apparently very reliable experiments, performed at least 
 
 * In the eleven years from the opening of the Homerton Fever Hospital to 
 October, 1 881, only two cases of fever (scarlet) have been admitted from the ad- 
 joining workhouse, viz. : — M. A. Kenning, on March 20, 1880, and the Labour 
 Master, in May, 1881. This latter case occurred when the Hospital had been 
 closed four weeks against the reception of fever, a few cases only of this 
 disease being located at that part (the eastern end) of the building mobt distant 
 from the workhouse. 
 
 t 1871 and 1876. The Guardians did not commence re -vaccination of the 
 inmates till December, 1876. The same immunity as here detailed obtained 
 during the epidemic of 18S0-1, when this "westernmost block of the 
 Homerton Fever Ho.spital " was for a third time used for the reception of 
 small-pox patients.
 
 17 
 
 loo years ago, and now probably forgotten by most medical men, it 
 would seem that the infective distance of the small-pox poison is very 
 much less than is generally supposed. 
 
 These experiments are detailed in English by John Haygarth,* 
 M.B., F R.S., Lond. and Edin., etc., being translated from the work of 
 Dr. 0'Ryan,t who performed them. First, he exposed six children 
 who had never had small-pox, and of course had never been vacci- 
 nated, for an hour at each sitting, morning, noon, and night, for a 
 whole week round a table of the diameter of three feet. On the 
 middle of this table was " a large dossil of cotton soaked in variolous 
 matter." This was renewed every second day, the poison being 
 alternately " taken from the inoculated and casual small-pox." No 
 alteration took place in the children's health till nine months after, 
 when four of them had a mild kind of small-pox. 
 
 Secondly, considering that the matter so used ''might have lost that 
 spring and that degree of energy which perhaps it may possess on 
 arising immediately from the human body," Dr. O'Ryan next " placed 
 a person in the eruptive fever of the small-pox by inoculation, at the 
 distance of about half a yard from four children properly prepared ; 
 each exposure continued one hour, and was repeated daily for a fort- 
 night, reckoning from the commencement of the fever until the pustules 
 had become perfectly dry. Not one of the four received the infection. 
 Two months afterwards " he " inoculated three of these children ; 
 they had the distemper in a very mild manner and recovered without 
 difficulty." 
 
 Dr. Haygarth observes : " These experiments . . . very nearly 
 determine the important question to what distance the infectious 
 atmosphere surrounds the variolous poison or patient " {op. cit. p. 84). 
 He also shrewdly says of them {pp. cit. p. 78), "they must strike every 
 reader of sound sense with irresistible conviction, if we except a few 
 over whose minds inveterate prejudices may have a more powerful 
 influence than the light of reason." 
 
 Again he observes : "The same facts which prove that an infectious 
 quality is communicated to the atmosphere by the variolous poison 
 contain a strong presumptive proof that this infectious quality will soon 
 be exhausted by exposure of the poison to the atmosphere " {pp. cit. 
 p. 104). In fact, he concludes that the circulation of a current of fresh 
 air through the sick chamber must soon deprive the poison of its infec- 
 tious quality {pp. cit. p. 106). 
 
 It is therefore abundantly evident that instead of suffi- 
 ciently developing the medical facts surrounding the 
 Hampstead Hospital case, the counsel for the defendants 
 and the Local Government Board, feeling certain that the 
 law was on their side, pressed too exclusively the legal 
 aspect of the suit. 
 
 * A sketch of a plan to exterminate the casual small-pox from Great 
 Britain. London, 1793, pp. 79-83. 
 
 t Dissertations sur les Fievres infectieuses et contagieuses. Par M. 
 O'Ryan, M.D. de I'Universite de Montpellier, Professeur en Medicine agrege 
 au College de Lyon. Voyez p. 37. 
 
 I am indebted to the courtesy of Dr. Alex. Collie, Medical Superintendent 
 of the Homerton Fever Plospital, for a knowledge of the above valuable works.
 
 i3 
 
 If the medical facts are to be put in evidence at all, 
 they must take the form, I presume, of affidavits, if per- 
 missible, when the appeal comes on before the House of 
 Lords. 
 
 The facts I have detailed (A, B, C, D, E) would seem to 
 establish that these infectious hospitals are not the danger 
 to the surrounding neighbourhood as is popularly sup- 
 posed. Homerton Hospital was actually built because 
 these diseases seemed to be always making their home in 
 that neighbourhood. It can indeed be shown that these 
 infectious diseases have a tendency, like the swallows, to 
 return to their old haunts,* and also that the relative mor- 
 tality of them varies in different epidemics. 
 
 We have just passed through an exceptionally extensive 
 epidemic of small-pox, with which it is, of course, as 
 absurd to charge the Asylums Boards as it is to blame the 
 Americans for the storms which they telegraph to us are 
 coming across the Atlantic. 
 
 If, as I have stated, the relative mortality of these diseases 
 varies in different epidemics, no value whatever can be 
 placed on fallacious and sensational statements, that the 
 mortality of small-pox during the time the Asylums 
 Board has been in existence is double to what it was 
 between 1851-60. 
 
 Mr. Sly has fallen into this remarkable error. He com- 
 pares the mortality of decades relatively epidemic-free with 
 the mortality of decades ichen tJiere were one or more severe 
 epidemics. Now, of course, there must be more small-pox 
 about when the disease is epidemic than when it is not; 
 and there must be more deaths from small-pox when it 
 is epidemic than when it is not. 
 
 Mr. Sly states: ''Between 1851-60 . . . the death- 
 rate from small-pox was 7,150." 
 
 "Between 1871-80 . . . the death-rate was 15,543, 
 or more than double." He omitted (vide Appendix B) to 
 tell us that in the former decade small-pox was relatively 
 epidemic-free, whilst in the latter decade there were th^'ee 
 severe epidemics, viz., in 1871, 1876 and 1880. 
 
 As Mr. Sly also pointed out the " death-rate " in the decade 
 
 * This fact is clearly established by a reference to the map furnished 
 by Dr. Tiipe, Medical Officer of Health to Hackney, which accom- 
 panied the memorial of the Hackney Sanitary Committee alluded to 
 at page 12.
 
 19 
 
 between 1861-70 was 8,347, ^^ 1,200 over and above the 
 immediately preceding decade. JBut why ? He says, not ! 
 In 1863 there was a severe epidemic of small-pox. Like a 
 great many other people, Mr. Sly takes theopportunity of run- 
 ning down vaccination and re-vaccination. He forgets that 
 it is Boards of Guardians, and not the Asylums Board, 
 who are responsible for the efficiency of these operations. 
 Dr. Stevens told us the other day what important factors 
 in keeping up the continuance of small-pox year after year 
 amongst us, were non-vaccination and bad vaccination. 
 
 Although the Asylums Board are powerless in this 
 matter, they can give you ample evidence of the power of 
 vaccination in diminishing the mortality of small-pox, as 
 showm by the following 
 
 RETURN. 
 
 
 Patients 
 
 admitted into 
 
 Small-pox 
 
 Hospitals of 
 
 Board. 
 
 
 or whom 
 
 Died 
 
 of the 
 Vaccinated. 
 
 Rnte of Mortality. 
 
 Year. ' 
 
 were were Un- 
 Vaccinated. vaccinated. 
 
 Vac- 
 cinated, 
 
 Un vac- 
 cinate i. 
 
 1870 
 187I 
 1872 
 
 1873 
 1874 
 
 1875 
 1876 
 
 1877 
 1^78 
 1879 
 
 l88o 
 
 j 13,905 
 
 174 
 112 
 
 89 
 1,290 
 
 [ 11,684 
 
 2,007 
 
 10,979 
 116 
 
 43 
 
 ^5 
 
 959 
 
 9,172 
 1,410 
 
 2,936 
 
 58 
 
 69 
 
 24 
 331 
 
 1,097 
 
 13 
 
 
 
 5 
 1C9 
 
 874 
 90 
 
 1 
 
 1 
 
 > 9-8 
 
 1 
 
 J 
 
 7-0 
 
 23-6 
 38-0 
 
 
 29,261 
 
 22,745 
 
 6,517 
 
 2,188 
 
 
 
 Now these figures materially qualify Mr. Sly's asser- 
 tion that despite the greater enforcement of vaccination, 
 the mortality from small-pox increases. In the nine years 
 ended 1879, the rate of mortality amongst the vaccinated 
 was 9'8 per cent. ; whilst in consequence of the greater 
 enforcement of vaccination during 1880, the percentage 
 diminished to 7*0. This improvement has resulted despite 
 the great extent of the present epidemic, the mortality of 
 which has been 38*0 per cent, amongst the unvaccinated, 
 whereas the total small-pox of the previous nine years 
 killed but 23 6 percent, of the same class. 
 
 Facts abound to prove that efficient vaccination and
 
 20 
 
 re-vaccination are capable both of preventing and of miti- 
 gating small-pox. 
 
 In the experience of the medical superintendents of the 
 Asylums Board's Hospitals, small-pox occurring in a 
 vaccinated person who can show three good foveated 
 marks of the vaccine pustules is not often fatal. Nor do 
 we ever see follow this modified small-pox any of those 
 horrible markings and serious sequelae, which used to be so 
 frequent in days gone by. * 
 
 In a circular letter from the Local Government Board, 
 signed John Lambert, and sent on 26th January, 1881, to 
 the several Boards of Guardians, occurs the following state- 
 ment : — 
 
 '' In addition to the experience of the London Small-pox Hospital 
 (dating from 1835) of the protective effect of re-vaccination as regards 
 the nurses and servants of that Institution, to which attention was 
 directed in the Board's official memorandum, the Board are now able 
 to refer to that of the Metropolitan Asylums Board, which shows that 
 of the numerous nurses employed by the managers in their large 
 hospitals, although such nurses inevitably come into contact with cases 
 of small- pox of the most m.alignant type, not one has ever died from 
 that disease ; and in the three or four instances in which they have con- 
 tracted it, it has shown itself in a very modified form. It has been the 
 practice to re-vaccinate these nurses on their entering upon their duties, 
 but not to repeat the operation ; and thus, so far as this very extensive 
 experience goes, it shows that re-vaccination, properly performed, 
 affords almost absolute protection from small-pox, and entire immunity 
 from fatal attacks of that disease."t 
 
 The protective power of vaccination on a larger scale is 
 shown in the national statistics of small-pox. In his Hand- 
 book of Vaccination, 1868, the late Dr. Edward Seaton 
 says (p. 252) : — 
 
 * From Dec. 8, 1876, to May 12, 1877,915 cases of small-pox were admitted 
 into the Homerton Hospital. Of these 131 cases were "unvaccinated," and 
 the mortality of them was 53 per cent. 
 
 396 cases had been "badly vaccinated," and the mortality of them was 26 
 per cent. 
 
 388 cases had been "fairly vaccinated," and the mortality of them was only 
 2-3 per cent. — Report, Committee of Management, 1877. 
 
 t Dr. Collie, the Medical Superintendent of the Homerton Hospital, informs 
 me that during the last three epidemics. of small-pox not a single official of this 
 hospital who had been efficiently re-vaccinated took the disease. In 1871 a 
 stoker and a kitchenmaid, whose re -vaccination had been overlooked, both 
 took the disease. A similar omission occurred in 1876. A ward servant, who 
 was not re-vaccinated, took the disease and died. 
 
 In 1880 every official escaped at Homerton. On the ship Atlas one 
 -lousemaid, whose re-vaccination had been overlooked, took the disease.
 
 21 
 
 " The decline of small-pox mortality exhibits a regular progression, 
 ill correspondence with the progress that has been made in the adoption 
 of vaccination. This is seen at a glance from the following 
 summary : — 
 
 Periods compared. 
 
 Annual deaths 
 by Small-pox 
 in England 
 and Wales. 
 
 Annual rate 
 per million 
 
 of the 
 population. 
 
 1. Average of thirty years previous to introduc- 
 tion of vaccination, estimated by Dr. Lettsom and 
 Sir Gilbert Blane 
 
 2. Average of three years (1838-40)* when 
 vaccination had become to a great extent diffused, 
 but before any public provision was made for its 
 gratuitous performance... 
 
 3. Average of nine t of the years (1841-53) when 
 public vaccination was gratuitously provided, but 
 vaccination was not obligatory ... 
 
 4. Average of the twelve years (1854-65) during 
 which vaccination has been to a certain extent 
 obligatory 
 
 11,944 
 
 5,221 
 
 3,967 
 
 3,000 
 770 
 
 202" 
 
 In fact in his twenty-eighth annual Report for the year 
 1865, the Registrar-General shows that, among the causes 
 of death, as arranged by him, small-pox, even in the worst 
 epidemic that had occurred during the twelve previous 
 years, occupied no higher than the eighteenth place, whereas 
 in England, thirty years prior to 1865, small-pox was, in 
 one of its years of epidemic prevalence, the fifth most fatal 
 disease. Vide Appendix C. 
 
 Now, sir, a few words as to the resolution itself We 
 are an executive body, sent here by the ratepayers to per- 
 form certain functions still allotted to us by law. We 
 should be a Board of action. To pass an abstract reso- 
 lution like this, will not, I am of opinion, avail the cause one 
 jot. On the contrary it will damage it. The resolution 
 will be regarded as a tainted resolution. It will be liable 
 to this rebuke, that it has originated from a feeling of petty 
 annoyance because powers which we used and a control 
 
 * Registration of the deaths in England began only in 1837. 
 t During the years 1843-46 the causes of death were not analysed in the 
 reports of the Registrar-General.
 
 42 
 
 which we had over public money for more than thirty 
 years, should have been, without any grave fault of ours, 
 taken away from us. 
 
 Depend upon it, sir, those days of unlimited power have 
 gone from us for ever. The Local Government Board, 
 having once tasted the sweets of centralisation, will never 
 again part with it ; nor will the Legislature ever sanction 
 the old regime of the Union System pure and simple to 
 revive in this metropolis. 
 
 We are more likely to see that in course of time the 
 Provincial Guardians will also have their powers curtailed. 
 But I would respectfully say to those gentlemen who think 
 otherwise, this is not the way to effect the alteration and 
 bring back the past. 
 
 The alleged extravagance of the Asylums Board is, as 
 both Mr. Sly and Mr. Bonnewell have said, a ratepayers' 
 question. Public meetings should be held of the rate- 
 payers and electors, so that pressure might be brought to 
 bear on our representatives in Parliament, which body can 
 alone alter a law of the land. 
 
 But I must tell you that representations on the expen- 
 diture will not avail you m.uch. In the Hampstead case, 
 the Judge remarked — Why did not the Asylums Board 
 buy a larger piece of ground ? The answer was — The 
 Board wished to save the ratepayers' money. The Judge 
 retorted — It was the Board's duty to purchase fifty acres if 
 eight acres were not an area of safety. The objections to 
 the continuance of the Asylums Board must, therefore, be 
 based on its past inefficiency, and that I contend neither 
 Mr. Sly nor anyone else can satisfactorily convince our 
 Parliament of. 
 
 One power was still left to Boards of Guardians, and I 
 trust this Board will not hesitate to exercise that power 
 mercilessly and ruthlessly. 
 
 If the Board be not satisfied with the conduct or votes of 
 any of their representatives on the Asylums Board, I hope 
 the Guardians will not wait till 1883, when the term of 
 office expires, but will at once pass a strong resolution con- 
 demnatory of their representatives ; and if that be done 
 they might take it for granted that they had my resignation 
 in their hands. So long, however, as I have the honour of 
 a seat on that Board, my conduct and votes will be primarily, 
 and I might say exclusively, governed by the interests of 
 the sick poor of the metropolis.
 
 APPENDIX. 
 
 A. — The statement as regards the ' ' Infirmary " still holds good . I have, how- 
 ever, a record of 15 cases of small-pox having been admitted from the 
 Workhouse proper, betw^een Feb. i, 1871, when the Hospital was opened, 
 and July 16, 1881. The floating, almost daily changing, population of the 
 Workhouse are, of course, permitted to visit at times their relatives and 
 friends outside the House. I am informed that in comparison with this W^oik- 
 house of the City of London Union, there have been a much larger per- 
 centage of both fever and small-pox cases in the more distant Workhouse of 
 the Hackney Union. In fact, before the Homerton Hospital was opened, 
 " the surrounding neighbourhood teemed with small-pox." 
 
 B. — Mr. Sly also omitted to tell us that in the decade 1841-50, the total 
 number of deaths {not'-'' death rate'''') from small-pox in London was 8,416, or 
 1,266 " over and above the immediately " succeeding decade, whefice he com- 
 menced his comparisons of mortality. 
 
 The fluctuation in the number of deaths from small-pox in London is shown 
 by the following summary, deduced from Table XXI. p. xxviii., Registrar- 
 General's Report, 1880 : — 
 
 Periods compared. 
 
 1. Average of ten years, 1841-50 
 
 2. Average of ten years, 1851-60 ... „. 
 
 3. Average of ten years, 1861-70 (Hardy's Act 
 passed 1867) ... ... ... ... 
 
 4. Average of ten years, 1871-80 (three severe 
 epidemics, vide C, infra) 
 
 Annual deaths 
 
 by Smallpox 
 
 in London 
 
 Annual rate 
 per million 
 
 of the 
 population. 
 
 400 
 
 277 
 
 276 
 
 C. — Since the delivery of my speech I have referred to the Forty-first 
 Annual Report of the Registrar-General (abstracts of 1878), Appendix, Tables 
 I and 2, pp. 228-9, 3.nd p. 235, with a view of ascertaining whether or not 
 
 * From Mr. Sly's figures, p. 18.
 
 this regular progression in the diminution of small-pox mortality was continuous 
 to the present time. 
 
 Subjoined is the result : — 
 
 
 Periods compared. 
 
 Annual deaths 
 
 of Small-pox 
 
 in England 
 
 and Wales. 
 
 Annual rate 
 per million 
 
 of the 
 population. 
 
 5 
 6 
 
 Average of the five years, 1866-70... 
 Average of ten years, 1871-80 
 
 2,756 
 
 *5,852 
 
 IIO 
 
 249 
 
 * This large increase is undoubtedly due to the great mortality of the last 
 three epidemics which have pervaded the Metropolis. The fearful epidemic 
 which came over to this country from France in 1 87 1 with a malignancy, said 
 by some to have been intensified by conditions incident to the Franco- 
 German War, slew in the two years 42,820. The epidemic of 1876-8 killed 
 8,542. The present, 1880-1, it has been computed, has already been fatal to 
 3»665. 
 
 There are many factors, which science will ultimately unravel, causative of 
 the differential mortality as between the Metropolis and the Provinces. The 
 actual augmentation in the London mortality began (B. supra) in the decade 
 1861-70. 
 
 R. F. 
 12, Old Burlington Street, W., 
 January^ 1882.

 
 ■'^^ wit