The aim of this study has been to comprehend the structure and dynamics of London's epidemiological regime within the framework of intermediate variables established in chapter 1. As such, the main lines of our conclusions emerge from the individual chapters and sections, but at this point we must say something about two issues which have not been directly addressed in the course of the text. These are, first of all, the problem of mortality decline, and, secondly, the factors ultimately determining both this latter process and the epidemiological regime prevailing during the earlier period of very high mortality.

The measurement of mortality levels in London is beset with too many difficulties for any very confident statements to be made either about its absolute level at any time, or about the precise timing of turning points in the secular trend. But what is clear is that mortality in the second quarter of the eighteenth century was very much higher than it had become by the early years of civil registration. Early eighteenth-century infant mortality was at least double the rate prevailing in the 1840s, and the gap between London and contemporary communities elsewhere in England was of a similar order of magnitude.

Infant mortality rates of this order were not of course unknown in pre-transitional western Europe, being equalled in communities practising artificial feeding.