silent for the best of reasons, viz., that they had nothing to communicate. Of those gentlemen to whose courtesy I am indebted for their replies only six had any cases under treatment. The testimony of all my correspondents excepting two was unanimous in this—that the disease generally assumed a mild form, and the correctness of this view was supported by the fact that although adults formed a large proportion of the cases, the few deaths that occurred were those of young children. The exceptions referred to went to prove the rule. The first-named was a group of seven cases in one house of a person in good circumstances, in which it was subsequently discovered that the cistern was not only in untrapped connection with the drains but was also in a disgusting condition of filthiness, to which cause my informant attributed the outbreak. This fact, however, may perhaps with greater probability be the explanation of the severity of the disease, and the sharp _sequelœ_ in all the cases. There were no deaths. In the second group of cases, eleven in number, occurring in three families of 21 persons occupying rooms in two small houses in a street at Notting Hill, there were five deaths, but, as I stated in my July report the causes of the severity and the fatality of the outbreak were to be found in the circumstances of the people and in their dwellings, “The fatality of the disease,” I remarked, “has been great in proportion to the number of cases . . . and this I attribute to the want of proper accommodation, etc., for the sick, the spread of the disease being the direct and necessary result of the retention for home treatment of first cases. It is practically impossible to isolate the patients in the crowded houses of the poor, and the parents are generally unwilling to allow their children to be removed to the hospital, the prejudice against which, however rarely survives actual experience.” In the same report I alluded to the concealment of cases, and to the fact that the registration of a death is oftentimes the first clue to the existence of the disease, and the information then comes too late for practical, i.e., _preventive_ purposes. It is obvious, also, after repeated experience that some of the poor who can ill afford to pay a doctor, employ the services of private medical men for fear that if they applied for Parish relief the sick child, or children, will be sent to the hospital. Private practice, is, under such circumstances, conducted under great disadvantages, for the payment of the small fees with which the medical man is content in such cases, deprives the poor of the means of purchasing those comforts, not to say necessaries, of the sick chamber, on which, _inter alia_, recovery so largely depends. It is heart-breaking to see the wan faces of little sick children in their miserable rooms, especially when the contrast is mentally made between the condition prevailing “at home,” and the