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In February, 1893, I reported to the Public Health Committee that in the previous few months
there had been an increasing prevalence of smallpox in London, first showing itself in the middle of
November, 1892, andattaining to proportions represented by the notification of 106 cases in January, 1893.
Inquiry of the medical officers of health had shown that of 104 cases of which particulars were obtained,
45 had been removed to hospital, or were directly traceable to other cases removed to hospital, from
casual wards, workhouses, infirmaries, Salvation Army shelters, and common lodging-houses. This report
was in April supplemented by another, stating that smallpox was continuing to increase, that the cases
notified had been 106 in January, 163 in February, and 272 in March. It had not been possible in the
majority of cases to determine the exact source of infection, but 234 were persons without settled lodging
or habitation. Of this 234 the source of infection appears to have been traceable in 19 instances to
common lodging-houses, in 39 instances to Salvation Arm}" shelters, in 15 instances to casual wards, in
27 instances to infirmaries, and in 13 instances to workhouses. The report of the Statistical Committee
of the Metropolitan Asylums Board, for the year 1893, contains a report by Dr. D. L. Long, second
medical officer of the River Ambulance Service, from which it is learnt that in the first six months of the
year, of the patients received by the Board, infection was traced in 96 cases to Salvation Army
shelters, in 16 cases to the Medland Hall, Ratcliffe, in 170 cases to common lodging-houses, in 17
cases to casual wards, and in 10 cases to other free shelters.
Details as to the part played by the nomadic class in disseminating smallpox are given by several
medical officers of health from whose reports the following is extracted. In Kensington, two cases of
smallpox occurred in common lodging-houses in the month of April. In Chelsea, in the beginning of
the year, several cases occurred in connection with the Chelsea workhouse and infirmary, the infection
being introduced on Christmas eve, 1892, by a tramp who was received into the casual ward. In
Fulham, seven cases occurred in the union infirmary, the disease being introduced by a man who came
from the casual ward at Epsom. In Westminster, of 42 cases occurring in the first six months of the
year, there were 16 at a common lodging-house in Great Peter-street, 14 at a Salvation Army shelter in
the Horseferry-road, and 3 among the employees of a licensed victualler carrying on business near
this lodging-house. In Hampstead, of 14 cases in 1893, one of the first two was a tramp who was
admitted into the casual ward of the workhouse on April 7th. after passing the night on the heath, and
who had previously been sleeping in various houses and sheds. Dr. Gwynn, the medical officer of health,
reports that it seemed to be clearly established that he had passed one night in the Salvation Army
shelter, Blackfriars-road, a centre of infection at that time to which many cases were subsequently
traced. In St. Giles, of 64 cases removed to hospital, 27 were removed from the casual ward and
common lodging-houses. In St. George-in-the-East, the disease was most prevalent in the early part of
the year, and was " confined for most part to the nomadic class." In St. George-the-Martyr, Southwark
the epidemic was most prevalent in the early spring, and reached its maximum in May. Dr. Waldo
the medical officer of health, reports that there are certain points in its behaviour worthy of notice, such
as (a) its origin and spread during November and December, 1892, and the first four months of 1893,