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infection were sufficient, and that the fact cannot thus be explained.
The cases in this southern district were more scattered than in
the north, and we had no such groups of cases in single houses or
in streets, &c., as I have had occasion to call attention to as occurring
in Kensal New Town, &c. The spread of the disease in a
general way may be attributed to the neglect of vaccination
under circumstances elsewhere adverted to, and especially to the
neglect of re-vaccination: to the concealment and consequent nonremoval
of cases, to the overcrowded condition of the houses, and
to the want of caution on the part of the sufferers, in the case of
adults: of the parents, when children were the victims. An adult
having a slight attack of modified small-pox may scarcely feel
ill, and if disinclined to go to the hospital, is still less disposed to
submit to the needful restraints "at home," And what a "home"
it is in too many cases! Who can wonder that the patient is glad
to get into the fresh air, and to mix with friends and neighbours?
Should the sickness be not severe, and the sufferer be not
much marked, say on the face, he or she is disposed to conceal the
nature of the illness and go to work—in the workshop or the
laundry, it may be. Here we have a fruitful sowing of the seeds
of disease; and even if the father or mother of the family be not
sick they often go to their daily labour from rooms full of' deadly
germs which they may convey in their clothes and sow broadcast.
The "clean clothes" sent home from the laundry may in like manner
become the channel of infection. Certain it is that in many cases
we have found manglers and ironers going constantly to and fro
between the pestilential "home" and the laundry, prior to the
report of sickness in their families. Children too, how difficult to
keep them at home when they begin to get better! Parents are
glad to get rid of them for quietness, and that the little ones may
benefit by the purer air outside the dwelling. And if they go
not out, how imposible it is to keep them to their rooms! On the
staircase the infection is constantly spread to other families in
houses let out in tenements. We have had. many well-authenticated
examples, moreover, of the spread of infection through every part
of the house, when there appears to have been a thorough anxiety
on all hands to prevent it—showing that in the strict sense of the
word, the sufferer was "without proper accommodation," though
lodged in a separate room with his nurse. But then, the nurse is
usually the wife or mother, and it is too much to expect that in
the ranks of the poor those precautions which are so successful
in large houses tenanted by single families can be practised; hence
it follows that there is no safety unless the patient is removed
without delay at the commencement of the attack, and the room,
clothing, &c., disinfected. In many instances where this has been
done, no second case has been recorded. It is astonishing, however,
how little people are impressed with the importance of