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from. 9 or 10 patients in a hospital. The evidence adduced by him
in favour of this is strong, but it does not follow, even if it did
occur in this particular instance, that it will or is likely to do so
on all or most occasions. My reasons for stating this, is that
the experience I have obtained here shows that the emanations
from some patients are much more infectious than from
others, not only as regards Small-pox, but as to Cholera, and
probably also Scarlet Fever. Thus, an outbreak occurred
some years ago in Shacklewell which arose from one family,
every member of which spread Small-pox wherever he went,
and eventually as many as 52 cases occurred in connection
with them. Something similar occurred in 1866, in the persons
of a family attacked with Cholera, when the attendants in the
German Hospital and others who attended on the sick took
the disease. I have seen the same happen, but to a much
more limited extent, in my private practice. In no case,
however, except that mentioned in Shacklewell, have I traced
the extension of the disease from other persons to anything like
this extent. Indeed, the history of the outbreaks of Small-pox in
the Clapton Park Estate in 1884 and in 1885, when the disease
was very prevalent, does not point to much of its spread in
this way, as the cause of infection could rarely be ascertained,
and yet repeated outbreaks, rather than a continued series of
attacks occurred. As regards aeërial infection I am more fully
persuaded than ever that it can and does happen, but I believe
that a particular state of the air, as regards moisture and
movement, as well as a particular condition of the patients as
regards infectiousness, are necessary to spread the disease
through the air, especially when a limited number only of
patients are contained in one building. I believe also that the
large Ward system at present in use in the Asylums Board's
Hospital is much more likely to be injurious than small Wards
containing only four or six patients. This question requires
much more investigation, but it is evident to my mind that
even with the reduced number of patients at present treated in