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the deaths in the epidemics of 1871-72, 1876-77, and 1880-81,
it appears an inevitable conclusion that the small-pox hospital
has exerted a decidedly injurious effect, ever since it was
opened, on the public health of this district.
The important question now arises: Is this injurious influence
unavoidable? In other words, is a small-pox hospital injurious
per se? The answer to this must depend partly on answers to
the following queries:—(a) Does the disease spread by aerial
infection? (b) If so, can the infective matter be destroyed
before the air charged with it passes outside? (c) If spread
chiefly or entirely by infected persons, i.e., by visitors, the sick
in ambulances, nurses, and other servants, can this be prevented?
(d) Does overcrowding the hospital, or the presence of a certain
number of patients in one ward or hospital, assist in spreading
the disease? and (e) Does the presence of a comparatively
small number of acute cases by themselves, in a hospital, act as
injuriously as a larger number of mixed cases?
The answer to the first question cannot safely be given at
present, but my opinion now is that the disease can be spread
by aerial infection. I say now, because, the outbreaks in some
of the streets adjacent to the hospital seemed inexplicable on
any other theory, yet the evidence was not so strong as I could
wish previously to the present epidemic. I however, stated this
to be my opinion in the evidence I gave before the Royal Commission
in 1882. The peculiar outbreak in March, 1884, seems
however to me to be conclusive in the matter. I will now proceed
to give a summary of the evidence as to other localities.
The street in which the disease was most prevalent in 1883-84
was Templar Road, which is situated on the western side of the
hospital, having the City of London Infirmary between them.
There were no less than 38 cases, although there are only 81
houses in the street, but more than once two or more cases
ocourred simultaneously in one house, without any ordinary
cause for the infection being traceable. Thus, in November,