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few in the aggregate, and I was aware, after repeated enquiry,
that the cases under treatment at the three charitable dispensaries
and by the five district Poor Law Medical Officers were astonishingly
few. In fact, on several occasions when enquiry was made,
it turned out that only one or two, or at the most three cases,
were under the care of the Medical Officers, although they have
many thousand cases of sickness among the poorest classes under
their care during the year. I also ascertained from many medical
men that they had very few cases under their care, most of them
none at all. I stated these facts in my. Tune report, but as the
alarm was really great I thought it well to address a circular
letter to the two hundred and fifty medical men whose names
appear in the Medical Directory as residents in Kensington, asking
for information and stating all I knew as to the actual dimensions
of the epidemic, if it could be so called, and the comparative abeyance
of scarlet fever in dispensary and parochial practice. To
this letter I had fewer than fifty replies, including those that were
viva voce. As I had asked for positive information only, it is probable
that many of those who did not favor me with any reply were
silent for the best of reasons, viz., that they had nothing to communicate.
Of those gentlemen to whose courtesy I am indebted
for their replies only six had any cases under treatment. The testimony
of all my correspondents excepting two was unanimous in
this—that the disease generally assumed a mild form, and the
correctness of this view was supported by the fact that although
adults formed a large proportion of the cases, the few deaths that
occurred were those of young children. The exceptions referred
to went to prove the rule. The first.named was a group of seven
cases in one house of a person in good circumstances, in which it
was subsequently discovered that the cistern was not only in un.
trapped connection with the drains but was also in a disgusting
condition of filthiness, to which cause my informant attributed the
outbreak. This fact, however, may perhaps with greater probability
be the explanation of the severity of the disease, and the
sharp sequeloe in all the cases. There were no deaths. In the
second group of cases, eleven in number, occurring in three families
of 21 persons occu pying rooms in two small houses in a street at Not.
ting Hill, there were five deaths, but, as I stated in my July report
the causes of the severity and the fatality of the outbreak were to
be found in the circumstances of the people and in their dwellings,
"The fatality of the disease," I remarked, "has been great in proportion
to the number of cases and this
I attribute to the want of proper accommodation, etc., for the sick,
the spread of the disease being the direct and necessary result
of the retention for home treatment of first cases. It is
practically impossible to isolate the patients in the crowded houses
of the poor, and the parents are generally unwilling to allow their
children to be removed to the hospital, the prejudice against which,
however rarely survives actual experience." In the same report I
alluded to the concealment of cases, and to the fact that the