692 SUPPLEMENTARY APPENDIX. 



most other towns, obtained in that year. Dr. Johnston reported that up 

 to 1884 the spread of small-pox from imported cases had been arrested in 

 20 instances by the means he adopted. 



His successor, Dr. Tomkins, though, like his predecessors, regretting 

 the increasing disuse of vaccination, bore testimony in his annual reports 

 to the efficacy of the measures adopted in Leicester, and expressed his 

 opinion that had such a system been in force at Sheffield in 1887 it would 

 not hare suffered in the way it did. 



In 1892 small-pox became prevalent in different parts of England, 

 especially in Lfincashire and Yorkshire. Many of the large provincial 

 towns suffered, and Leicester amongst them. There were, in 1892-3, 357 

 cases of small-pox in Leicester, of whom 21, or 5-8, died ; 193 households 

 were invaded, containing 1234 persons. The first importation was by a 

 tramp, whose disease, passing unrecognised, caused infection at a common 

 lodging-house and at the workhouse. Eleven other importations of the 

 disease by tramps occurred in the course of 1892-3. 



Leicester suffered less than many of the other large towns which have 

 been invaded by small-pox during recent years, both in the number of 

 cases and in the number of deaths. In connection with this, however, 

 a point to which we have already called attention must be borne in mind. 

 Tlie disease was remarkably slight there in its fatality, even as regards 

 those who, by reason of their age, could not be affected by the change of 

 practice in relation to vaccination. Dr. Priestley, the Medical Officer of 

 Health, claims, in his report to the Sanitary Committee for 1893, that 

 it was by reason of the energetic methods adopted that the disease had 

 been prevented running riot through the town. His claim may be well 

 founded. At all events, the experience of Leicester affords cogent 

 evidence that the vigilant and prompt application of isolation, etc., even 

 with the defects which were brought to light during the recent epidemic, 

 is a most powerful agent in limiting the spread of small-pox. It is true 

 that the system and appliances which appeared adequate for some years 

 failed to prevent a serious outbreak of small-pox in 1892-3. We think 

 its value was none the less real. 



Stamping-out System in London. 



In the Report of the Royal Commission of 1881, already alluded to, 

 suggestions were made with regard to notification and isolation which 

 have since been largely carried into, effect. As we have said, it was con- 

 sidered proved that the existing small-pox hospitals had caused a spread 

 of the disease in their neighbourhood. We cannot but think that this 

 may in some measure account for the greatly increased mortality from 

 small-pox in London during the 1871-72 epidemic as compared withthe 

 rest of the country. It is true that the statistics relating to England and 

 Wales outside the Metropolis include those of other large towns where the 

 same evil was present ; but it probably did not exist there in so aggravated 

 a form, and the effect may be neutralised by the statistics relating to 

 smaller towns and rural districts with which they are combined. This 

 idea has been suggested to us, as the result of the inquiry, how it has come 

 about that whilst the Metropolis, in the decennium 1867-76, and again 



