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showed signs of increased prevalence, and in the middle of November
151 cases were under treatment, since when there has been a slow but
regular decline, the number of cases in Hospital numbering 93 on
December 31st. In Fulham 32 cases have been notified, but of these
3 were found by the Medical Officer of the River Ambulance Service
not to have Smallpox and were not sent on to the Hospital Ships, but
were sent back to their homes, one of the cases being detained at the
Wharf for six days before a final decision was arrived at. The
difficulty of diagnosing many cases of Smallpox is well known and it
must be remembered that as London was practically free from Smallpox
during the six years prior to 1812, many practitioners have never
had the opportunity of seeing cases of the disease, mistakes of this
nature must almost of necessity be not infrequent. Thus in 1891, of
90 patients throughout London certified to be suffering from Smallpox
and removed from their homes by the Metropolitan Asylum's Board's
ambulances, 27 or 30 per cent. proved not to have Smallpox. In 1892
out of 412 cases, 93 or 22 per cent. and this year of 2.557 cases, 274
or 10 per cent. were similarly found to have been incorrectly certified.
It is however obvious that as the arrangements of the Managers for
removing patients are so admirable, that there can be no danger to the
patient in removal, and as the patient is not allowed to proceed to the
Hospital Ships and so be exposed to infection until the diagnosis is
confirmed, it is better where means of complete isolation are wanting
that doubtful cases should be at once notified, so that they can be
promptly removed and isolated, than that the risk should be run of
spreading the disease broadcast by the neglect, or the impossibility
of taking the proper precautions. The disastrous effect of this was
shown recently in an adjoining parish, where a case of Smallpox was
unrecognized until just before death, with the result that the disease
rapidly spread in the neighbourhood and some 70 persons were
attacked. Of the cases notified in Fulham all but two were removed,
one of these being well isolated, and in the other case the exhaustion
consequent on the extreme age of the patient, viz., 85, in the opinion
of the Medical attendant forbade removal. Three of the cases proved
fatal, being equivalent to a death rate of .03, the rate for the whole of
London being .0.4; the average rate for the previous ten years having
been .07. The following table gives the age and condition of the
patient as regards vaccination, together with the result of the case:—