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parish, during a period of three or four months, viz., from August to
November, 1878. But, in December, a concealed and fatal case
occurred at Seymour Place, Fulham Road. Between that date and
the end of January, 1879, eight other cases occurred, and of these
five were treated at home, one at Pelham Street (fatal), three
at Richmond Road (two of them fatal), and one at Ifield Road
(also fatal). Thus, to say nothing of "concealed" cases of which we
subsequently obtained information (there were two consecutive cases in
one room at Sumner Mews, the continuance of the disease extending
over many weeks), we had six local centres of infection at the very
commencement of the fresh outbreak- at a time moreover, when for
many weeks we had flattered ourselves that our efforts to eradicate the
disease had at last been crowned with success. It happened moreover,
as it nearly always does when an epidemic disease first breaks
out, that the first cases were not reported. Unless death ensues weeks
may elapase before an epidemic disease is known to exist. Such was the
case at the beginning of this great epidemic at Islington in 1876, and
such was the case at the beginning of the last outbreak in Brompton,
which is still progressing. So soon as we knew that the disease had
re-appeared in the parish our efforts were again directed to the isolation
of the sick in hospital, not with complete success at any time, and least
of all at first, and thus the disease got a good hold in the district. As
soon as cases began to flow freely into the hospital persons aware of that
fact, but ignorant of what had gone before, jumped to the conclusion
that the hospital—our greatest ally in measures for coping with the
epidemic, was in fact the means by which the disease was originated
and spread.
In my second report for 1879 (dated March 5th), 1 recorded eleven
cases—including the two at Sumner Mews referred to above as having
been concealed, until our services were required for the disinfection of
the sick room. The remaining nine cases were removed to the hospital
after more or less loss of time, due to delay in diagnosis or in reporting
the cases, but they had established several other centres of
infection. In the third report (dated April 2nd), 28 cases were
recorded, of which 15 occurred in the south district: and in the fourth
report (April 30th), 27 cases, all in the South district. In the
fifth report (May 28th) the known cases fell to 10, eight in the