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appears likely that he contracted his small-pox from the Mitchell
Street infection. No. 257 nursed him during the early stage of his
illness, and contracted the disease. Nos. 258 and 269 both contracted
the small-pox from this source. Every effort was made to
prevent the spread of infection from this public house. On two
occasions I advised its closure, and everything was thoroughly
disinfected. But from this source and from the Mitchell Street
source infection unfortunately spread into Bastwick Street, the
inhabitants of which street are constantly in and out of houses in
Central Street, Mitchell Street and the immediate neighbourhood.
In this way I think there is no doubt that Nos. 253-268 and Nos.
270-272 contracted the small-pox. Twelve cases occurred in Bastwick
Street. Every possible effort was made and the most stringent
precautions taken, and to this alone I attribute the fact that the
outbreak was checked. The fresh cases, numbering 40 in all, were
due to deliberate neglect of vaccination, and to deliberate concealment
of the disease when it first appeared. Out of the 40 new cases there
were eight deaths. Five of these deaths were due to confluent
small-pox and three to hæmorrhagic small-pox. Six of these deaths
were of patients who had never been vaccinated, and the other two
had not been vaccinated during the last 10 years.
Whilst these were the eight chief groups of cases, it may be said
at once that the vast majority of the cases were contracted from
previous cases which had either been notified, or were so mild as
to escape recognition, or be passing under other descriptions, such
as "influenza" or "chicken-pox." Several cases were tramps, and
many others were contracted in workshops or infected areas in other
parts of London. Doubtless some cases in other Boroughs were
contracted in Finsbury. Probably however, a Central Borough, and
particularly one so overcrowded as Finsbury, is on that account all
the more likely to extraneous infection than a Borough on the
circumference of the Metropolitan area. A number of cases were
contracted by persons visiting the small-pox ships and refusing
vaccination. (See Appendix.)
Conclusions.—It will thus be seen that we have 88 cases of
small-pox and 10 deaths in 1901, and 187 cases and 30 deaths in
1902. In old days there ware not infrequently outbreaks of the