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or unrecognised cases of small-pox. Hence laundries, common
lodging-houses, workshops, clubs, overcrowded tenements, and
similar properties have provided the main opportunities for the
spread of the disease.
The infection of small-pox is so subtle and so readily spread, and
the disease is, in some cases, so mild and so readily concealed that
no one can tell when he may be exposed to it and thus attacked by
it unawares. It would appear that the infection is mainly given off
(1) by the skin of persons suffering from small-pox, possibly during
the incubation stage, certainly in the initial stage, but most
virulently when the skin is pustular or scabbing; (2) from bodies of
persons who have died from small-pox; (3) from infected articles
and anything handled by the patient; (4) from healthy
persons who have been in contact with the disease ; (5) by the air
from small-pox hospitals, houses or patients ; hence the importance
of rapid and total isolation of each case.
The question naturally arises, Why has there been such a marked
increase in 1901 and 1902 ?
In my Annual Report for Clerkenwell, 1900 (pp. 24, 25) I pointed
out that the prevalence or otherwise of small-pox depended on
(a) The amount of small-pox in other districts of London.
(b) The prompt recognition of any cases of small-pox and their
early isolation to hospital.
(c) The state of vaccination of the community.
(d) General sanitation and freedom from overcrowding.
Now it happens that the present epidemic in Finsbury illustrates
these four points, and it will be well to deal briefly with them—
(a) Small-pox in other London Districts. — As I have already pointed
out, the first cases occurring in Finsbury derived their infection in
other parts of London, and we have had perhaps half a dozen other
similar cases. On the other hand we have been responsible for
causing infection in persons not living in Finsbury. All over the
Metropolitan area such cases have, of course, been numerous. Nor
is this remarkable. The more remarkable fact is that, with smallpox
prevalent in Islington (351 cases) and Shoreditch (456), and