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14
contact, that is to say, by infected persons or things coming or
being brought near to the healthy, is the ordinary manner in
which the disease is spread. An examination of the order
in which the cases occurred, at any rate in the early part of an
epidemic, shows that there was an outbreak at first nearly 14
days after the first cases. For instance, at Hackney Wick,
a severe outbreak took place on October 30th (one case having
occurred on the 17th), and others subsequently on the 14th and
15th of November, and I have noticed this in every epidemio at
different plaoes. I mention Haokney Wick because it is
comparatively isolated from the remainder of the distriot and
surrounded by open country. Every precaution should therefore
be taken to prevent a hospital being a source of infeotion to a
neighbourhood, both as regards the structure and the general
and ambulance arrangements. At Homerton, as the tradespeople
and others have to enter the hospital grounds to deliver goods,
and as there is only one common entrance for patients and
visitors to the Small-pox and Fever Hospitals, I cannot say
that the best practical means have hitherto been carried out,
although they will, I hope, soon be, by the completion of the
works now nearly finished.
One question of great moment is the number of patients who
may be treated at one time in a small-pox hospital without
much risk to the inhabitants of the surrounding neighbourhood.
During an early period after the establishment of the hospital,
the disease did not become epidemic in its vicinity until nearly
80 patients were in the hospital; but I stated in 1882, before
the Royal Commission, that I did not think more than 60
patients should be placed on the site at Homerton. I then
referred to mixed cases, and especially mentioned small wards,
as I believe that the present wards are too large, and allow the
aggregation of too many patients in one room. I cannot now
say that 60 or even 30 patients suffering in the acute stage oan
be safely treated at Homerton; but as a very large number of