Nevertheless, that the sanitary condition of the City has undergone considerable improvement within the last two years is a fact which no one can gainsay; and that a considerable share of the mitigation in mortality arises from this improvement cannot reasonably be questioned. If even a third of the mitigation in question, if a reduction of ten _per cent._ on the preventable mortality of the City, may be inferred from the materials which I lay before you, it is indeed matter for the utmost congratulation; and a continuance of the same reduction year by year, perpetuated (as doubtlessly it may be) by a continuance of the same exertions, would soon raise the City of London above all fear of comparison, on the ground of healthiness, with urban or suburban populations.
Thirdly, I would beg the attention of your Hon. Court to those very important _local differences_ of death-rate which may be deduced from a study of our death-register. I have already had the pleasure of citing to you the low rate of mortality which has prevailed during the last year in the north-west sub-district of the City of London Union. The rate of death in the north division of the West London Union was nearly double that proportion; and between these extreme terms of disparity there were many intermediate degrees.
Similar inequalities of mortality were observable in last year’s record. In the healthiest sub-district of the City the year’s death-rate was about 22 in the thousand; while in the worst it stood above 41; and for the whole West London Union exceeded 38.[38]
[38] I have here availed myself of the corrections given in the note of page 6.
Mainly and essentially these local differences of mortality depend on the proportion in which _preventable deaths_ enter into the total; the differences, however partial, depending on the operation within certain districts, of removable deleterious influences which do not exist in certain other districts.
In classifying for your consideration the deaths which, during the last two years, have depended on epidemic, endemic, and infectious diseases, I have thought it desirable to distribute them according to the municipal divisions of the City. Strongly believing, as I have endeavoured to express, that this class of deaths is for the main part preventable, I have thought it would interest the representatives of the several Wards, and would more directly enlist their sympathies for sanitary progress, if I could enable them at a glance to recognise the ratio in which their respective constituencies contribute to this annual death-roll. I have included in the table, under eight different heads, all those acute diseases which depend in an important degree on local causation, either for their existence or for their fatality. It will be obvious, even to the unprofessional reader, that local causes are not of equal prevalence in respect of all the diseases there tabulated. Some (as fever and cholera) would not be known at all under perfect sanitary arrangements; others (as scarlatina, measles, and hooping-cough) would be far less malignant in their attacks; others (as those classified in the tenth and twelfth columns) would no doubt exist under the most perfect physical circumstances, but would probably prevail in numbers quite inconsiderable as compared with those actually observed.