LONDON SANITARY IMPROVEMENTS. 323 



Now, in the whole of the Final Report, I can find no recognition 

 whatever of the remarkable and exceptional improvement in the gen- 

 eral health of London that has been shown to have occurred in the 

 period embracing the end of the last and the beginning of the pres- 

 ent centuries; nor of the equally exceptional changes of various kinds, 

 all tending to improved health in the people. And, in view of the 

 facts here adduced, the statement of the Royal Commissioners that 

 "no evidence is forthcoming to show that during the first quarter of 

 the nineteenth century these improvements differentiated that quar- 

 ter from the preceding quarter or half of the preceding century in 

 any way at all comparable to the extent of the differentiation in 

 respect to small-pox," has, I submit, been shown to be wholly 

 erroneous. 



And with respect to the absence of proof of similar changes having 

 occurred in other European countries, which they also urge against 

 the sanitation theory, we hardly need any such proof in detail. The 

 very fact of the immediate adoption of vaccination in all the more 

 civilized countries shows how rapid was the spread of ideas and of 

 customs at that very period. And when we consider, further, that 

 in the last century all the great European cities were at about the 

 same level of filth and unhealthiness with London, and that a century 

 later there is not much difference between them, the probability is 

 in favor of their having all advanced approximately paripassu. And 

 with regard to the all-important change in diet and other habits, the 

 same rule applies. The use of potatoes and of tea or coffee, the bet- 

 ter water supply, drainage, ventilation, and good roads were all 

 adopted, in France and Germany, at all events, approximately 

 about the same period as with us. Hence it is not surprising that a 

 similar diminution in general mortality as well as in mortality from 

 zymotic diseases, including small-pox, should have occurred almost 

 simultaneously. The fact that when we have fairly good statistics, 

 as in Sweden ; the great improvement in small-pox mortality is shown 

 to have occurred before the introduction of vaccination or before it 

 could have affected more than a small fraction of the population, 

 sufficiently proves that this was the case. 



I have now supplied the last piece of confirmatory evidence which 

 the Commissioners declared was not forthcoming; not because I think 

 it at all necessary for the complete condemnation of vaccination, but 

 because it affords another illustration of the curious inability of this 

 Commission to recognize any causes as influencing the diminution of 

 small-pox except that operation. In this, as in all the other cases I 



