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away with small-pox returned to his home. On the day of his return and the day
following he was in conversation with two young girls living in the house. Both these
girls developed small-pox after an interval indicating that infection had taken place
about the date of the young man's return. The girls were employed at different places,
one at business, the other at school, and it is unlikely that they received infection where
they were employed (see Table IX. cases 201, 301 and 302)
As is the case with other diseases, the occurrence of small-pox, especially at the
commencement of an outbreak, is accompanied by more or less risk of delay in the
recognition of cases. In a large proportion cases of small-pox are diagnosed on the
third and fourth days of the disease, when the eruption has developed sufficiently to
enable the medical attendant to pronounce it that of small-pox. Sometimes, however,
owing to various reasons, it may be a week or even longer before the nature of the
illness is recognised and measures as to preventing the spread of the disease can be
taken. On the other hand, in a fair number of cases the diagnosis may be made and
the necessary precautions taken in less than three days. It is hardly necessary to
observe that early isolation of small-pox cases is of the greatest importance in preventing
the spread of infection. In a district like Shoreditch isolation is practically
impossible, except by the removal of the patient to hospital. It is satisfactory to state
that every certified case of small-pox which occurred during the outbreak with the exception
of one or two which terminated fatally, the bodies being removed with proper
precautions to the Mortuary, was removed to the hospital of the Metropolitan Asylums
Board, and that the admirable arrangements made by the Board for the removal of
the cases, so far as the experience in Shoreditch went, worked without a hitch.

In one of the cases, removed on the 21st day from the beginning of the illness,
the eruption was observed 19 days before removal. Although the history of the commencement
of the attack is not quite definite, the patient appears to have been ill two
days before the eruption was noticed. The patient, who had been vaccinated on account
of having been exposed to small-pox, was thought at the time the eruption came
out to be suffering from the effects of the vaccination. In the other case the patient
was thought to have chicken-pox, and the case was certified as being chicken-pox. The
nature of the illness was recognised when three other members of the family developed
small-pox. The case removed on the 28th day of the disease was brought to light on
the occurrence of several well-marked cases of small-pox in the patient s family. It
was a very slight case. In addition to the cases dealt with in the above table, some
21 others occurred, in which the histories were not sufficiently definite to admit of
their being included in the table.