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193
a fertile cause of the diffusion of small-pox bring about indirectly
a reduction of mortality from that disease. Great as such
influence must have been, and great as were the efforts which
were now for the first time made to restrict the spread of smallpox—by
efforts directed against contagion—there were, in
addition, those other influences at work during the last quarter of
the 18th century to which we have already alluded, influences
which have been continued and intensified during the present
century, and which, in our opinion, must be credited with a considerable
share in the reduction of small-pox.
We agree with those witnesses who are of opinion that
inoculation, as practised in this country and many parts of
Europe last century, did tend to increase the prevalence and
mortality from small-pox, that it introduced the disease into
places that, in all probability, would have remained exempt from
it, and in some large towns like London it tended to keep the
contagion alive and make the disease endemic. It appears, however,
from the Bills that its introduction did not at once or very
materially increase the mortality from small-pox in London.
This was, doubtless, owing to the fact that it was scarcely
possible to make matters much worse then than they were before
in regard to the number of small-pox deaths.
We are led to believe that but for the disease being kept
alive by inoculation, the improvement of the public health which
set in towards the end of the 18th century, in obedience to the
causes to which we have alluded, would have brought about an
earlier and greater decline of small-pox mortality. The mere
substitution of a non-contagious process like vaccination for the
old inoculation in a population of whom some 80 per cent. or
more had acquired naturally or artifically such protection as
previous small-pox affords would have a striking effect upon the
small-pox death-rate by reducing the liability to infection of the
remaining susceptible.
We think there can be no doubt that, speaking generally, in
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