Owing to the constant intercourse between England and France it was inevitable that small-pox should very soon be conveyed into England; the persons who conveyed it were probably French refugees. As on the continent, so also in England, small-pox was always prevalent; in the years 1869 and 1870, however, it was not very widespread, and it did not begin to gain much headway until the autumn of 1870. The number of deaths caused by small-pox in England was: _All told._ _Per 10,000 inhabitants._ 1868 2,052 0·9 1869 1,565 0·7 1870 2,620 1·2 1871 23,126 10·1 1872 19,094 8·3 1873 2,264 1·0 In the first nine months of the year 1870 there was no increase in the small-pox mortality, but in the last three months, and from January 1871 on, the increase was very marked. The number of deaths caused by the disease was: 1870. 1871. First 405 4,903 Second quarter 446 7,012 Third quarter 500 4,612 Fourth quarter 1,229 6,380 These figures do not agree with the figures for the years 1870–1 given in the previous table, and the reason for this is not explained in the report. The places where the disease first entered England were London, Liverpool, and the mining districts of Durham and South Wales (Monmouth). The compiler of the reports regarding the movement of the population in England in the year 1871 says:[300] ‘Nearly all the smaller outbreaks may be more or less directly traced to one of these centres; Brighton, for instance, doubtless suffered from its intimate communication with London. There is distinct evidence in many cases of the introduction of the disease into sea-side towns by sailors, and considering its fatal prevalence in Holland, Belgium, and many parts of France, it is not a matter for great surprise that Southampton, Great Grimsby, and one or two other ports suffered from the epidemic. It is indeed very probable that the epidemic in London was due to the large arrivals of French refugees during the latter part of the previous autumn. That the epidemic may to a great extent be traced to our foreign communications is beyond doubt, and it is to be regretted that the steady decline of deaths from small-pox in the six years 1864–9 had induced a certain apathy in the matter of vaccination, and thus left a large portion of the population unprotected from the disease. In times of severe epidemics large numbers of the vaccinated in some way or other also suffer for the neglect which has left so many unvaccinated.’ The number of deaths caused by small-pox in London was: