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any given case has probably been due to a patient
returned from hospital, care has to be taken to
inquire into the disinfection of the rooms, bedding,
etc.; to the washing of linen; the disposal of books
and toys; and lastly, the interval that has elapsed
since the patient arrived home. All cases occurring
after about nine days have been excluded. The
inquiries have in all cases been personally made
by the medical officer of health.
Finally, it may be stated that the occurrence of
return cases is not an experience confined to the
Metropolis, but common to almost all hospitals. It
is accepted by all, or nearly all, medical officers, that
such cases are frequently due to the patients
returning from hospital, although it is very difficult
to explain how they arise or, what is far more
important, how they are to be prevented.
Small-pox.—Of the 10 cases of this disease notified
during the year, in two the patients were pronounced
by the hospital authorities to be suffering from other
diseases (chicken-pox in the one case, and enteric fever
in the other.) All the 8 cases of variola were in adults
who had been vaccinated in infancy only. Three cases off
Westbourne Grove constituted the only group of connected
cases. The dates of sickening of these patients indicated
that there were two independent sources of infection. The
strictest inquiries were made as to the movements of the
patients but no trace of the origin could be obtained.
Another patient came home ill with the disease from
Westminster. The Medical Officer of that district was
informed of the case, but no origin was discovered.
Another patient had had a young relative staying with