232 



QUARANTINE AND SMALLPOX. 



isolation was not perfectly maintained ; and that the vaccination of 

 quarantine officers was not thorough, since two caught the disease on duty. 



Distribution of disease .-—The total number of households known to have 

 been infected was 88. Of these 74 per cent, were situated within the city, 

 while 22 per cent, stood in boroughs continuous with it and but little less 

 densely populated. The remainder (or 5 houses only) stood in boroughs 

 rather more remote, and much less densely populated; in three of them 

 the disease did not make its appearance until after the third month of the 

 outbreak, although a large proportion of the inhabitants went backwards 

 and forwards to town every day. 



All these circumstances being considered together, it becomes clear that 

 the contagium showed very little activity, and that almost all the cases 

 must have been due to contact either with the sick themselves or with 

 fomites ; at all events its aerial diffusion was so slight as to be negligable. 

 And, as a matter of recorded observation, of 103 cases which happened 

 after September 2, when note of the source of infection first began to 

 be taken, 70 per cent, were found to have been infected either by contact 

 with the sick, or by fomites, or by close contiguity of the sick in an 

 adjoining house — a large proportion to be thus traced in a crowded city. 

 Lastly, although communication was easy and remained uninterrupted, 

 there was no spread of the disease to other cities or to the country districts. 



Smallpox would be a disease but little formidable if, under similar 

 circumstances, it always showed itself as sluggish as it did on that 

 occasion. Compare this with the case of the city of Montreal in the 

 fall of 1885, where no less than 2,500 persons lay sick on a single 

 clay, and the total deaths amounted to more than 1,000. No one I 

 think, can doubt that something more than mere neglect or break- 

 down of quarantine was there at work. I make these remarks 

 because t no longer care to share in the administration of a scheme 

 of defence against small-pox which I see is valued by the public 

 far beyond its true worth, without stating my opinion, that, useful 

 as it undoubtedly is, and necessary to be retained whatever 

 additional steps we may take to defend ourselves, it is not to be 

 reckoned upon to prevent the spread of a true epidemic. When 

 the three conditions happen to coincide here, we shall suffer even 

 as Montreal did, and as a thousand other cities have done ; and 

 it is scarcely doubtful that then the public will be prone to blame 

 the administration of the Health Department of the Government. 

 But I declare beforehand that that blame will be unmerited, 

 unless the Department shall have connived at the neglect of what 

 is the only true protection against small-pox ; I mean vaccination. 

 But successive Chiefs of that Department have again and again 

 urged it ; and, for the twentieth time I disclaim any such 

 connivance, and I venture to do so not less for the profession of 

 this city as a whole, than for myself individually. The Government, 

 however, cannot enforce vaccination among the people, since it is 

 believed (I know not how reasonably) that they will have none of 

 it ; but when the time of epidemic comes, as soon or late it must 

 come, it will be the people who will sutler, and not the doctors or 

 their families. 



