"Whilst, during the first twenty years of the Board's experience, London was again and again visited with epidemics of smallpox, during the past seven years it has, thanks to the action of the managers in having removed to and isolated at Long Reach all cases of the disease, been practically non-existent as a health disturbing factor. "The percentage mortality of smallpox cases treated by the Board decreased from 20·81 in 1871 to 4·0 in 1896, and the annual mortality from 2·42 to practically zero." The rate of death from diphtheria also showed a continuous fall, and this fall had been coincident with the introduction and increasing use of the anti-toxic serum treatment of the disease. A valuable criticism on the existing machinery for the sanitary government of London was given in a report of the Metropolitan Asylums Board Statistical Committee in June, 1892:-- "Although London possesses an ambulance service and a system of hospitals admittedly unrivalled, yet it has no central authority charged with the duties of tracing out an outbreak of this infectious disease (smallpox), and of taking concerted action towards stamping it out by measures of disinfection and vaccination and re-vaccination. "These matters still remain in the hands partly of the 41 local sanitary authorities, partly of the Local Government Board, and partly of the London County Council. "Clearly the present arrangements are not only cumbrous and incapable of that rapid action essential to success in dealing with infectious disease, but they are also excessively expensive." In connection with hospital accommodation there were two other factors in the sanitary evolution of London. One of these was the provision made by the Poor Law for the treatment and care of the sick poor.[182] Previous to 1867 the accommodation provided by the Poor Law for the sick was in the sick wards of the workhouses. The Act of that year, which had established the Metropolitan Asylums Board, laid the basis for the removal to separate hospitals of paupers suffering from the worst forms of infectious disease. The same Act authorised the building and establishment of Poor Law infirmaries, thus removing most of the sick from the workhouse wards, giving them better treatment and better prospect of recovery. In 1892 the number of new infirmaries was 24, containing 12,445 beds; but a large proportion of the sick were still kept in the workhouses, the returns for 1890 showing about 4,000 occupied beds in them.