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children, in respect of an ailment which they have come to
regard as at once inevitable and not very serious. Often enough
the fatal event takes them by surprise, as when it is immediately
due to some complication, e.g., convulsions — the
secondary cause of death in many cases. Pulmonary complications
are the most frequent. Not very many deaths are
returned as due to whooping cough alone ; and even in such
cases it is open to question whether there may not have been
complications which the certifying practitioners thought it
unnecessary to mention, upon the ground that the said complications
were secondary to the specific disease, and but for it
would not have existed at all. This observation raises the question
whether the complications referred to are avoidable or
otherwise? Now, whilst I have no doubt that, in some instances,
complications, e.g., chest diseases, are unavoidable, I am, nevertheless,
of opinion that the secondary diseases are frequently
due to want of care in the home treatment of the sufferers—
though I by no means would imply that such want of care
proceeds from indifference, still less from unkindness. The
little ones are not, perhaps cannot be, confined to a single room,
kept at an even temperature : they catch cold ; the " cold " and
the " cough " are not differentiated. Medical treatment is not
sought until the child is obviously very ill, and when it is
obtained, the child is beyond the reach of help. The deaths recorded
within the year from whooping eougli, were, as stated, 119;
but it is to be feared that the deaths really due to this disease
exceeded even this large total, for whilst on the one hand it is
probable, as before stated, that whooping cough is sometimes
returned as the sole cause of death, notwithstanding the
existence of complications; on the other hand, there is ground
for believing that sometimes the primary disease is not mentioned
in the medical certificate of the cause of death, the immediate
cause of death alone being stated, e.g., bronchitis or pneumonia.
A locality which suffered considerably from this whooping
cough epidemic is that at the back of Kensington Square —not
3 very good one in respect of the construction and sanitary