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inference from the deaths at that time, there being no notification
of disease; but supposing the mortality be put at 10 per
cent., there must have been no less than 79,000 cases.
Thanks to notification, to the Asylums Board and to improved
sanitary administration, although possible it is not
probable that the Metropolis will again pass through a like
experience.
In 1884 and 1885 small-pox was epidemic in Marylebone,
over 500 cases occurring in each of those years.
In 1894 there were nearly 300 cases, and 29 deaths, but
this last was rather a local outbreak than an epidemic, and was
rapidly got under control. Since 1895 small-pox has been
practically absent from the district until June, 1901, when a case
of unrecognised small-pox, imported from Paris, infected a nurse
in St. Mary's district, and the nurse, after a few days' illness,
died of a malignant form of the malady. Three other cases
followed in different parts of the borough, these having no bond
of connection with the first case; then in the latter end of
August came a flood of infection from St. Pancras, the
district affected being a thickly-populated area in the neighbourhood
of Tottenham Court Road. The preventive measures taken
exercised a marked control, and from September 30th to the end
of December the number of notifications did not reach 25.
During the whole year the total number of cases was 63,
of these 8 (that is 12 per cent.) have proved fatal.
PREVENTIVE MEASURES.
The first preventive measure is without doubt vaccination
and re-vaccination.
The public generally have no just ideas as to vaccination.
On both sides—those who are against, and those who are for,
have made statements tending to obscure the question. In the
first place there is common ground in the belief that one attack of
such infectious fevers as scarlet fever, measles, whooping cough,
and so forth confers more or less immunity from a second
attack, but the immunity is variable, and not always persistent
through life. Most medical practitioners can, from their own
experience, cite instances of persons having two and even three
attacks of the same kind of fever. The writer has known a man
badly pitted from a former attack of small-pox die from