1^2 



Mr. Gwyther 07i the 



general distribution of small-pox. And that, therefore, we 

 must use better sanitary means for dealing with it. The 

 means seem to be three : — 



1. Better methods of protecting the individual. 



2. Better methodsof preventing the spread of an epidemic. 



3. Better methods of preventing the rise of an epidemicr.^ 

 With regard to the latter of these methods, careful 



search ought to be made to find out whether small-pox is 

 endemic in any localities ; this may possibly be the case 

 without any great small-pox mortality, as it is quite con- 

 ceivable, and not indeed unlikely, that small-pox is not very 

 fatal when the circumstances which favour an epidemic are 

 not present : nor is it necessary that in case of an epidemic 

 it should be most fatal in the locality where it has been 

 endemic. 



Especially does London deserve a complete examination 

 of this kind, as its death rate from small-pox now maintains 

 itself at sixfold that of the rest of England, as is shown in 

 this table, taken from the Report of the Medical Officer 

 for 1884. 



The special circumstances of London seem from this 

 table to have been very favourable to small-pox, as they show 

 no decline comparable with that of the rest of England. 

 In 1886 there was a complete change, there were only 5 

 deaths in London returned as from small-pox, — i between 20 

 and 25, 2 between 25 and 35, and 2 between 35 and 45. 

 Nor during the previous term of years was the epidemic 

 without intervals. It is during these periods of quiescence 



