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one person suffering from unrecognised small-pox into these
caravanserais, may be the means of infecting numbers of the inmates,
who carry, during their wanderings, the infection latent in the system
into other districts of London, or into the surrounding country.
It is now becoming generally recognised that increased powers
are required to deal with the spread of infection by the nomadic
class; and some authorities are of opinion that legislation is
required to enable local sanitary authorities to inaugurate a system
of ticket registration for the identification of individuals, together
with compulsory medical examination in casual wards, common
lodging-houses, and shelters, with the ability to detain without a
justice's order, those who have been directly exposed in common
dormitories to infection, temporary shelter during the period of
incubation being accorded the detenus at the cost of the sanitary
authority.
Scarlet Fever.—This disease began to assume an increased prevalence
early in the summer, and continued to increase until October,
when the maximum number of cases were notified. The fever
hospitals of the Metropolitan Asylums Board became filled at the
end of July as against September in 1892, with the result of a much
larger number of cases being unable to obtain admission, either
altogether, or until after a delay of a varying number of days.
Appended is a list of the infectious cases (scarlet fever 71 cases,
diphtheria 2 cases) which were delayed in removal to the fever
hospitals. This list gives the initials and age of each person, the
address (without the number of the house), the disease, the date of
receipt of the notification, and the date at which the case was
removed to the hospital, or in which permission was withdrawn for
removal, the patient being recovered, or at any rate supposed to
have recovered. Application had to be made by letter, telegram,
or by personal visit to the ambulance station, or to the Asylums
Board office, every morning for each one of the cases delayed in
removal, otherwise they would have been passed over. In urgent
cases, where the infection of a whole family of children was
imminent, strenuous efforts by personal visits and exhortation at
the chief office of the Asylums Board, had to be undertaken, and it
is gratifying to know that in these cases the representations of the
Public Health Department were usually well attended to.