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sanitary administration above referred to. Every other large
centre of population has but one Sanitary Authority. Every one
is interested in stamping out small-pox; cases of the disease are
reported and isolated, and epidemic prevalence is prevented, the
result being that since 1875, when the Public Health Act was
passed, and Medical Officers were appointed to all parts, smallpox
has not, to my knowledge, prevailed in any town, or other
place, with the severity which was so common in the absence
of such sanitary arrangements during the epidemic of 1870-3."
(5) NOTIFICATION OF INFECTIOUS DISEASES.
I have prepared the subjoined table with a view of tracing, if
possible, the effect, if any, upon the prevalence of infectious
disease, of the legislation of 1875. In that year the Public
Health Act was passed, under the provisions of which Medical
Officers of Health were appointed in all parts of the kingdom.
I have limited the inquiry into the number of deaths (in
London and the 19 other large towns of England) to the one
disease—small-pox—because there is a more earnest endeavour,
everywhere and by all persons, to stamp out this terrible disease
by isolation, &c., than is manifested in respect of any other disease.
There is probably less concealment of small-pox than of any
other disease, and parents who would conceal a case—of scarlet
fever, for example—would generally be found willing to disclose and
permit the removal of a case of small-pox. Again, there is more
co-operation between the public and medical men on the one side
and Medical Officers of Health on the other side, for the extirpation
of small-pox than in respect of any other disease; and therefore,
probably, small-pox prevalence does furnish a reliable test in the
circumstances. Since 1875 the mortality from small-pox outside
London has greatly diminished, and London alone has suffered
severely during the recent epidemic, 1876-81.