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CHAP. III
LONDON SMALL-POX
85

the Royal Commissioners! And if we turn to the other half of the diagram showing the period of registration, the difficulty becomes even greater. We first have a period from 1838 to 1870, in which the zymotics actually rose; and from 1838 to 1871, averaging the great epidemic with the preceding ten years, we find that small-pox also rose, or at the best remained quite stationary. From 1871 to 1875 zymotics are much lower, but run quite parallel with small-pox; then there is a slight decline in both, and zymotics and small-pox remain lower in the last ten years than they have ever been before, although in this last period vaccination has greatly diminished.

Turning to the upper line, showing the death-rate from all causes, we again find a parallelism throughout, indicating improved general conditions acting upon all diseases. The decline of the total death-rate from 1760 to 1810 is remarkably great, and it continues at a somewhat less rate to 1830, just as do the zymotics and small-pox. Then commences a period from 1840 to 1870 of hardly perceptible decline partly due to successive epidemics of cholera, again running parallel with the course of the zymotics and of small-pox, followed by a great decline to the present time, corresponding in amount to that at the beginning of the century.

The Commissioners repeatedly call attention to the fact that the mortality from measles has not at all declined and that other zymotics have not declined in the same proportion as small-pox, and they argue: "If improved sanitary conditions were the cause of small-pox becoming less, we should expect to see that they had exercised a similar influence over almost all other diseases. Why should they not produce the same effect in the case of measles, scarlet fever, whooping-cough, and indeed any disease spread by contagion or infection and from which recovery was possible?" This seems a most extraordinary position to be taken in view of the well-known disappearance of various diseases at different epochs. Why did leprosy almost