Smallpox no longer claims its victims in any considerable numbers except in communities where vaccination is neglected; cholera has been excluded from our country during the last two widespread epidemics in Europe and its ravages have been greatly restricted in all civilized countries into which it has been introduced; the deadly plague of the seventeenth and eighteenth centuries is no longer known in Europe and the prevalence of typhus so—called spotted or 'ship fever'—has been greatly limited. Typhoid fever, tuberculosis and diphtheria are still with us and claim many victims, but we know the specific cause of each of these diseases; we know where to find the bacteria that cause them and the channels by which they gain access to the human body; and we know how to destroy them by disinfecting agents.
The mortality from tuberculosis is constantly diminishing in our large cities and the complete destruction of the infectious sputa of those suffering from pulmonary tuberculosis would no doubt go a long way towards the extermination of this fatal disease.
Perhaps the triumphs of preventive medicine can not be better illustrated than by a brief historical account of the prevalence of bubonic plague during the past three or four centuries. It can scarcely be doubted that the 'black death' of the fourteenth century was the same disease which subsequently prevailed in Europe under the name of 'the plague'—now more generally spoken of as 'bubonic plague.' While modern methods of diagnosis have enabled us to recognize typhoid fever, typhus fever, relapsing fever and bubonic plague as distinct diseases, it must be remembered that up to the end of the fifteenth century no such differentiation had been made and the term 'pest' was applied to any fatal malady which prevailed as an epidemic, and no doubt in some instances included smallpox, which prior to the discovery of Jenner contributed largely to the general mortality of the population of Europe.
Bubonic plague continued to prevail in various parts of Europe at the end of the sixteenth century, and early in the seventeenth century (1603) an epidemic occurred in London which caused the death of 38,000 of its inhabitants. It continued to prevail in this city and in various parts of England, Holland and Germany and six years later caused a mortality of 11,785 in the city of London. During the year 1603 a most disastrous epidemic occurred in Egypt, which is said to have caused a mortality of at least a million. After an interval of ten or fifteen years, during which there was a marked diminution in the number of cases and the extent of its distribution in European countries, it again obtained wide prevalence during the year 1620 and subsequently, especially in Germany, Holland and England. The epidemic in the city of London in 1625 caused a mortality of more than 35,000. In 1630 a severe epidemic occurred in Milan, and in 1636 London
