On August 17 and 18, seven infected Frenchmen arrived at the city of Düsseldorf and were at once isolated in a house outside the city limits; in November a few more infected prisoners arrived. In the small German garrison (523 men) no cases were observed until later (April and May). In December 1870, 20 cases among the civil inhabitants were reported; they constituted the beginning of an epidemic which developed rapidly, reached its climax in July with 648 cases, and then quickly disappeared. In the following year, 524 small-pox patients (75·0 per 10,000 inhabitants) died in the city of Düsseldorf. In the district of Duisburg eleven cases of small-pox were reported in December 1870, and here again the epidemic developed rapidly, reaching its climax (1,549 cases) in May 1871. The city of Duisburg was most severely attacked; 529 persons (173·2 per 10,000 inhabitants) died there of small-pox in the year 1871. In the stronghold of Wesel (district of Rees), where the prisoners were confined in the stronghold itself on Buderich Island and Spellmer Heath, persons suffering from small-pox arrived in August and September; and still more arrived in November with a transport of prisoners from Metz. Of the 16,299 prisoners, 1,042 (63·9 per 1,000) contracted small-pox, and 127 (12·2 per cent of those taken sick) died; the largest number of cases was reported in January. In the garrison, which numbered 7,284 men, there were 117 cases of the disease and seven deaths. Since the inhabitants of the city of Wesel and of the surrounding country had continual intercourse with the prisoners, the dissemination of the disease was inevitable; the epidemic among the civil inhabitants began in November and carried away nine persons in 1870 and eighty-four persons in 1871. In Elberfeld the epidemic did not become very widespread until December 1871. The first fatal case in the city of Essen was reported in January 1871; the epidemic then increased in fury until June 1871 (48 deaths), when it began to abate. In the following year it revived a little in May, when 26 cases were reported. All told, 272 persons (53·0 per 10,000 inhabitants) died of small-pox in Essen in the year 1871, and 112 persons (21·0 per 10,000) in the year 1872.[274]