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period, so that a severe epidemic might have been anticipated
about the time it occurred, owing to the large number of
persons, especially of the poor, who escaped vaccination in
infancy before 1874, and the almost total neglect of re-vaccination,
as well as to the number unprotected by a previous
attack of the disease.
Large as is this mortality of 39.8 per 100,000 population,
when we consider the almost total immunity from death
afforded by proper re-vaccination, it is as nothing if compared
with the death rates which occurred when vaccination
was unknown. During the seven years 1629-35, when the
disease was not unusually prevalent, the annual death rate
in London was 189 per 100,000; in the 20 years 1660-79, it
reached the high figure of 417 per 100,000; whilst in the 30
years 1728-57, it had increased to 426. During the ten
years 1771-80, just a century before the decennial period
1871-80, the disease caused a mortality of 502 deaths per
100,000 population. From this time the mortality became
less, the annual death rate for the ten years 1801-10, having
been 204, and for 1831-35, 83 per 100,000 population.
During the years 1681-90 and 1746-55, small pox caused
one-twelfth of the total number of deaths from all causes.*
It is therefore very evident, that as small pox in London
increased with the density of the population between 1660
and 1780, but has decreased to one-fifteenth part of what it
was in 1771-80, although the density of the population has
enormously increased of late years, that some cause for
the decline must have been in operation, especially during
the last 40 years, and that cause I believe chiefly to be the
greater extent to which vaccination has been practised
during this latter period. Sad as it is to think that so many
lives have been lost even lately for want of proper re-vaccination,
yet the glance backwards is certainly one of a
reassuring character.
During the 10 years 1861-70, comparatively few deaths
*See Papers relating to Vaccination, General Board of Health, 1857.