square mile, another column showing in how many of the years during the period 1859–1882 there were any small-pox deaths in the districts. The result shown is very remarkable. In the most thinly populated district no small-pox death occurred in any one of the twenty-four years; in the most densely peopled districts small-pox deaths occurred in every one of the twenty-four years. And the frequency of the occurrence of small-pox in all the intervening groups of districts followed exactly the density of the population. Taking two groups with nearly the same population, the fourth group of 107 districts, with a total population of 1,840,581, had small-pox deaths in only five or six out of the twenty-four years in any of them; while the thirteenth group of thirteen districts, with a population of 1,908,838, had small-pox deaths in twenty-three out of the twenty-four years. But the first group had a density of 160 to the square mile, and the last had 8,350 to the square mile. The Commissioners dwell upon the alleged fact that neither water-supply, nor drainage, nor contaminated food produce small-pox, and urge that what is commonly understood by sanitation has little effect upon it (par. 153). But what may be termed the fundamental principle of sanitation is the avoidance of overcrowding; and this is shown by an overwhelming body of evidence invariably to influence small-pox mortality quite irrespective of vaccination.[1]
Yet the remarkable contribution to the mass of evidence in the "Reports" which brings out this fact most clearly, receives no notice whatever in the Final Report.
- ↑ It is not alleged that over-crowding, per se, is the direct cause of small-pox, or of any other zymotic disease. It is, perhaps rather a condition than a cause; but under our present social economy it is so universally associated with various causes of disease—impure air, bad drainage, bad water supply, unhealthy situations, unwholesome food, overwork, and filth of every description in houses, clothing, and persons—that it affords the most general and convenient indication of an unhealthy as opposed to a healthy mode of life, and, while especially applying to zymotic diseases, is also so generally prejudicial to health as to produce a constant and very large effect upon the total mortality.
