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place the case may be wilfully concealed to avoid compulsory
removal to hospital. In the 1901-2 outbreak, wilful
concealment was more than suspected in several cases, and, in
one case, was proved, and the offender convicted and fined.
But the chief difficulty arises from the occurrence of cases so
slight as to escape recognition. This difficulty occurs in
connection with all infectious diseases, but is most marked in
Small-pox owing to the influence of vaccination in modifying
the character of the disease. The cases which escape recognition
occur in persons who have been vaccinated at a date
sufficiently remote for the vaccination to have lost the power of
protecting against attack while retaining the power of greatly
modifying the severity of the disease. In other words, the
cases occur in young adults who have been efficiently vaccinated
in infancy. It is not too much to say that the occurrence of
the slight, modified cases of Small-pox, which, by escaping
recognition, play so prominent a part in the spread of the
disease, are in a great measure due to the present state of
the law relating to vaccination, which insists on infantile
vaccination without making provision for re-vaccination. The
slight cases escape recognition for two reasons. In the first
place, the patient's health may be so little affected by the attack
that he may not think it necessary to consult a medical man,
or even to cease following his occupation; and, secondly,
although a medical man may be consulted, he may fail to make
a correct diagnosis. Mild cases of Small-pox may be
mistaken for chicken-pox, influenza, ague, impetigo, measles,
syphilis, or other diseases. Four out of the 33 cases
in 1903 were treated by their medical attendant for periods
varying from one to nearly three weeks for disease other than
Small-pox, and while so treated they were following their
ordinary occupations as if nothing out of the common had
happened.
It must not be supposed, however, that errors of this
kind were peculiar to Battersea. Mistakes in diagnosis
involving serious consequences occurred all over the country.
There can be no doubt that man)' medical practitioners are
unable to diagnose modified cases of Small-pox; but this is