death-rate from 1870 to 1881; and the other just following the two small-pox epidemics of 1844 and 1848, thus supporting the view that it is in process of replacing that disease. Scarlatina and diphtheria show the high rate of zymotics generally from 1848 to 1870, with a large though irregular decline subsequently. Whooping-cough shows a nearly level course to 1882 and then a well-marked decline. Fevers (typhus, enteric, and simple) show the usual high middle period, but with an earlier and more continuous decline than any of the other zymotic diseases. We thus see that all these diseases exhibit common features though in very different degrees, all indicating the action of general causes, some of which it is by no means difficult to point out.
In 1845 began the great development of our railway system, and with it the rapid growth of London, from a population of two millions in 1844 to one of four millions in 1884. This rapid growth of population was at first accompanied with over-crowding, and as no adequate measures of sanitation were then provided the conditions were prepared for that increase of zymotic disease which constitutes so remarkable a feature of the London death-rates between 1848 and 1866. But at the latter date commenced a considerable decline both in the total mortality and in that from all the zymotic diseases, except measles and small-pox, but more especially in fevers and diphtheria, and this decrease is equally well explained by the completion, in 1865, of that gigantic work, the main drainage of London. The last marked decline in small-pox, in fevers, and to a less marked degree in whooping-cough, is coincident with a recognition of the fact that hospitals are themselves often centres of contagion, and the establishment of floating hospitals for London cases of small-pox. Perhaps even more beneficial was the modern system of excluding sewergas from houses.
We thus see that the increase or decrease of the chief zymotic diseases in London during the period
