4. It is granted that the disease may be produced and variously modified
by many causes besides contagion, and more especially by epidemic and
endemic influences. But this is not peculiar to the disease in question.
There is no doubt that small-pox is propagated to a great extent by
contagion, yet it goes through the same periods of periodical increase
and diminution which have been remarked in puerperal fever. If the
question is asked how we are to reconcile the great variations in the
mortality of puerperal fever in different seasons and places with the
supposition of contagion, I will answer it by another question from Mr.
Farr"s letter to the Registrar-General.

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