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whether the epidemic when it does escape from its bonds 
may not prove more fearful than ever in its ravages. 
Not only do these tables show the fact, but the whole 
history of epidemics proves that when a disease has been 
long absent from a country, on its return it is always both 
more virulent and more widely spread than when it is to 
some extent endemic amongst the people. This fact comes 
out very strikingly in the history of the small-pox, as 
given by Mr. Simon, and in outbreaks of measles in remote 
islands. Might we not then do serious harm by attempting 
to postpone the evil day of visitation ? 
This is a serious question for those who are now trying 
to arrest the progress of epidemic disease, and I fear that 
it would have to be answered in the affirmative if our 
energies were mainly devoted to isolation and disinfection 
whilst the other conditions are left intact, which are known 
to favour the propagation and vitality of these disorders. 
George Eliot is right in thinking that “you cannot fright 
the coming pest with border fortresses, ” and whilst filth, 
overcrowding, impure water supplies, and bad drainage are 
permitted to remain amongst us, it is highly probable that 
any temporary limitation of an epidemic will only serve 
to husband its strength, and give it more material to feed 
upon in the future. 
But fortunately we are not necessarily impaled upon the 
horns of the dilemma of either being destroyed now or at 
some future period of our career. 
In the case of the most serious of these maladies, scarlet 
fever, it is certainly not essential that every one should 
take it, and its power is probably greatly influenced by 
sanitary conditions. 
I can hardly doubt that the great increase of this com- 
plaint of late years in Sweden is due to the circumstance 
that sanitary regulations have not kept pace with the 
growth of the population, and we must never forget that, 
