"(_a_) Sanitary supervision. (_b_) Removal to hospitals. (_c_) Disinfection. (_d_) Expenses in hospital. (_e_) Cost of burial. (_f_) Loss of work in wages. (_g_) Loss of life to the community. (_h_) Cost of widows and children." And the Medical Officer of Health for Whitechapel wrote in 1871:-- "... As the local rates are continually increasing for the relief of sickness and the support of widows and orphans, the building of asylums for the insane, and the providing of workhouse infirmaries for the debilitated and prematurely old, it is probable that local boards will direct more attention to the condition of the houses of the poor than they have hitherto done." The cost was brought home to them in 1871--"an exceptional year of mortality caused by the continued spread of smallpox." "It has been," wrote the Medical Officer of Health for Lambeth, "one of the most alarming and expensive epidemics that have visited the country for a century. The cost in a pecuniary sense has been great, but it is nothing as compared to the cost of human life. "... I know of no disease that can be made so preventable as this." The Medical Officer of Health for St. George-the-Martyr wrote:-- "No extravagance can be compared with that of sanitary neglect. Pounds are willingly paid for cure, where ha'pence would be grudged to prevent. Some diseases we can create, most we can propagate, and send on their errand of misery and destruction." In 1878 the Medical Officer of Health for Whitechapel again referred to the subject:-- "It may be asserted without fear of contradiction, that all money laid out for the improvement of the public health will secure an ample dividend.... "The alleviation of suffering and the prolongation of human life is the duty of every noble-minded man to endeavour to promote. "It cannot be too frequently reiterated, too extensively known, that the rich not only pay a heavy pecuniary penalty, but often suffer a heavy affliction in themselves and families by neglecting to improve the sanitary condition of the houses and localities occupied by the poor. It is well known that defective sanitary arrangements in the poorer localities are the chief causes of disease among the poor, and when a contagious disease is once located it soon assumes an epidemic form and attacks, indiscriminately, all classes of the people." These views were sound and true, but the contingencies described always appeared remote, and arguments of more immediate and remunerative results were constantly present.