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59
smith, not more than 20, while there were about 180 concealed in
Fulham. The reasons for coming to these conclusions are, that
of the 5 cases which were first reported in the death returns there
were 4 in the parish of Fulham, and only 1 in the parish of Hammersmith,
besides which there was much less reluctance shown to
reporting cases in the latter parish than in the former. Of the
139 cases which were properly isolated at the Metropolitan
Asylum Hospital, at Fulham, 129 were removed there by your
Board, 1 case by the Fulham Board of Guardians, 2 cases by St.
George's Hospital, and 1 case by the German Hospital. The
patients applied to these hospitals for advice, and were at once
removed to Fulham Hospital, 6 patients walked to the hospital.
Of the 27 cases not properly isolated, 14 refused to allow removal.
The isolation in these cases was not sufficiently bad to obtain
a magistrate's order for removal, and was not sufficiently good to
be satisfactory. Five cases were first reported after the death of
the patients, from one of these no less a number than 28 persons
contracted the disease before the case became known to an officer
of your Board. The first intimation I received of the case was by
telegram at 8 o'clock in the morning. When I arrived at the
house about 9 a.m. I found the patient had been dead some hours.
No sanitary precautions had been adopted, and the consequence
was that 28 persons were attacked by the disease, 7 of whom
died. It is lamentable on the one hand, and most satisfactory on
the other to compare the results that followed this case with those
that followed nearly 100 cases, which were immediately reported
to your Board. We see in one instance wholesale death and
affliction, and on the other the disease on nearly every occasion at
once stamped out. Nine cases were not reported till after recovery.
Cases were known to have afterwards occurred through the imperfect
isolation of these. One case was too bad to be removed.
The medical attendant gave no information till the patient was "in
articulo mortis," when he requested immediate removal, although
he had been in professional attendance for 6 or 7 days. The Inspector
seeing the state of the patient, hesitated to remove him
and applied to me for further instructions, but before I could see
the case he was dead. Two other persons caught the disease
from this case and were removed to the hospital by your Board.
Owing to the removal of the cases to the Metropolitan Asylum
Hospital, instead of the Highate, by an arrangement which I
* effected with the Asylum Board the previous year, no less a sum
than £238 was directly saved on the cost of the maintenance of
the patients last year, besides which there was a saving in the
expense of removal, and last, but not least, it must have been an
incalculable advantage to the patients to be spared the long
journey to Highgate. In accordance with a provision of the
"Poor Law Amendment Act, 1879, your Board are empowered