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leaves behind it an extreme debility of long continuance. Being liable
to spread through the entire of a poor family lodged together in a
single room, it will have thus, if not checked, the effect of throwing
additional burdens upon the poor rates. The most important measure
of prevention would be the removal of the first case occurring in any
house to a hospital. The disease which commenced among the Polish
Jews in Whitechapel has now spread throughout the Metropolis, and is
spreading and increasing now. Even should it shortly abate, which is
scarcely likely, it is said, we may look for its replacement by a worse
disease, namely, Typhus. Up to October, the only known cases in this
parish were in tramps, but recently a case was sent to the hospital from
Andover Gardens, and it has appeared since October in Rose and Crown
Court. In one room five cases have occurred, four of which are in
hospital now; and in another room of another house, I saw to-day
three cases, which I requested Mr. Turner to send away at once.
I must, in the existing state of things at the London Fever Hospital,
suggest your adoption of one of two courses, either that you should
make such arrangements with the managers of that hospital as will ensure
the reception there of all the cases we may think it necessary to send,
advising the guardians to direct their Medical Officers to forward there
every case of fever that comes under their notice; or that under the
powers given you by the 37th section of the Sanitary Act, you should
provide a temporary place for the reception of the sick.
I may remind you that whatever steps you may adopt, it should be
adopted at once, before the disease has made headway among our poor
population, otherwise it will be futile for any preventive purpose.

The highest day temperature, observed on October 9th was 74.0°
The lowest night temperature, observed on October 28th was 28.0°.
EDWARD BALLARD, M.D.,
Medical Officer of Health.
Vestry Offices,
November 13th, 1869.