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74
eighteenth century and earlier was influenced by sanitary conditions,
is one rendered difficult by the lack of exact information.
We may distinguish between overcrowding as one insanitary
condition and all other insanitary conditions, such as lack of
cleanliness and the like. A priori we should expect that a dense
population, especially one of great internal movement, and one in
continual interchange with surrounding populations, by offering
greater facilities for the conveyance of contagion, would lead to a
greater amount of Small.Pox. London was a conspicuous
instance of the above, and the apparent greater prevalence of
Small.Pox in London than in the provinces may be attributed to
these causes; but it would appear that the increase was felt, as
indeed would, a priori, seem probable, rather in the constant
presence of Small.Pox to a considerable amount at all times than
in the mortality of the epidemics when these occurred.
It may be urged against the view that the decline of
Small.Pox was due to improved sanitary conditions, in the first
place, that, admitting the introduction of sanitary improvements,
no evidence is forthcoming to show that during the first quarter
of the nineteenth century these improvements differentiated that
quarter from the last quarter, or half, of the preceding century in
any way at all comparable to the extent of the differentiation in
respect to Small.Pox. In the second place, admitting a priori
that crowded dwellings tend to increase the liability to contagion,
and so the prevalence of the disease, while other insanitary
conditions tend in addition to increase the fatality among those
attacked, so that insanitary conditions as a whole must tend to
increase the mortality from Small.Pox ; no evidence is forthcoming
which distinctly shows that the dependence of the prevalence of,
or the mortality from, Small.Pox, on the lack of sanitary
conditions, was a feature of the history of Small.Pox during the
eighteenth century.
Moreover, it must be remembered that the decline in
Small.Pox mortality was observed in Western Europe in countries