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by the agency of male vagrants, (b) its subsequent distribution amongst the residential population,
particularly in the poorer parts, and (c) the important part played in the spread of the disease by the
unregulated Salvation Army and other shelters. In St. Olave, the first case and nearly all the others
occurred in a common lodging-house in Tooley-street. In Wandsworth parish, of the first two cases,
one occurred in a common lodging-house and the other in a casual ward. In Plumstead the cases of
small-pox occurred mostly in localities frequented by tramps.
During the months of March, April and May, 8 cases of smallpox occurred in the Council's
common lodging-house in Parker-street, St. Giles. The distribution of the cases in point of time led
to the conclusion that the first case was the source of infection of the second, the second case of the
third, the third of the fourth, fifth, and sixth, and the sixth of the seventh and eighth. The first patient
had, with the exception of four or five nights, slept continuously in the house for more than three
weeks. In connection with the earlier cases, it was decided to rely on the removal to hospital of the
sick person, upon disinfection, and upon giving facilities for the vaccination of the inmates of the house.
Later it was resolved to exclude the admission of new comers to the house until a sufficient interval of
freedom from smallpox had elapsed.
In the early part of the year the Council addressed a letter to the several sanitary authorities
referring to the increasing prevalence of smallpox in London, and to the number of cases occurring in
casual wards, workhouse infirmaries, Salvation Army shelters and common lodging-houses, and
suggesting the desirableness of special facilities being afforded for the vaccination of the employees and
lodgers at all such places. The Metropolitan Asylums Board also communicated with these
authorities, forwarding a copy of a report by the medical superintendent of the hospital ships
in which the incidence of the disease on the nomadic class was pointed out. The Managers urged
the adoption of some measures for preventing the further spread of the disease in London, and suggested that
"one most effective means to that end would be a systematic medical inspection of casual wards, shelters,
common lodging-houses, &c., through the agency of which it would appear there is risk of the disease
being widely disseminated." The reportsof some of the medical officersof health show the action taken by
their authorities. Thus in Kensington, St. Giles, Limehouse, Bow, and Newington, letters were addressed
to the managers and keepers of such places explaining the chief symptoms of the disease, urging them
to watch for any appearance of smallpox in their lodgers, and advising them of the course to be taken in
the event of any suspected case occurring. The Limehouse District Board recommended the medical
inspection of inmates of these places, and were informed by the Salvation Army authorities that they would
provide such inspection if the Board were willing to pay the costs, by the Medland Hall authorities that they
would take steps to give effect to the suggestions of the Board, and by the police that efficient medical
inspection was impossible, and that they had no funds for the purpose. The Vestry of St. George-inthe-East,
on receipt of the Council's letter, arranged with the Board of Guardians for a letter to be
written to the keepers of common lodging-houses, requesting them to post a printed notice in the several
dormitories, to the effect that the public vaccinator attended at the vaccination station on a certain day
in each week for the purpose of vaccinating people free of charge, and that any lodgers making
application on that day could be vaccinated; and further, the Vestry arranged with the Board of
Guardians for the public vaccinator to call at the common lodging-houses in the parish once or twice
a week with the necessary lymph for vaccinating any inmate who would be willing to submit to the
operation.
Of the local prevalences in the year recorded by medical officers of health, the following are the
most important—
The medical officer of health of Greenwich reports that three cases of smallpox occurred in
Blackwall-lane in January. The first case was that of a woman vaccinated in infancy who had a mild
and, at the time, unrecognised attack. Her two unvaccinated children were the next sufferers, and
one of these children died." Mr. Hartt states that " in a short time 75 cases were reported as occurring
in the streets adjoining Blackwall-lane, principally amongst children attending the board school in that
locality, many of which could be traced to the Blackwall-lane cases. In one school alone I found 34
children and in another 27 without any visible mark of vaccination. It was found that in the majority
of cases the unvaccinated child first contracted the disease, and then brought it home and infected the
other members of the family, many of whom had been vaccinated. These latter cases were of a mild
type"
The medical officer of health of Camberwell states that between December 3rd, 1892, and
October, 1893, he received intimation of 150 cases of smallpox. " Of these 115 were removed to hospital
and 35 were treated at home. Of those removed to hospital 10 were returned as not suffering from
smallpox. In the case of 5 of these 10 no subsequent case of smallpox occurred in the house, and it
may be presumed that they were not cases of smallpox. Of the other 5 smallpox recurred in the
house in 3 cases, and in the remaining 2, one case was returned after three days owing to its
doubtful character, while the other ' was allowed after he had recovered from his illness, for which he
was treated at home, to go to the Metropolitan Asylums Board Convalescent Farm.' Of the 35 cases
which were not removed, 10 were probably not smallpox. In all but 2 instances wherever an
unremoved case of undoubted smallpox existed, other cases followed, mostly in the same house. The
occurrence of smallpox in Barset-road led to the discovery of a man who was found to be suffering from
smallpox, although he had been at work up to the time of our visiting the house."
The medical officer of health of Bow reports " nine cases of smallpox occurred in a house in
Windon-street. First case 8 months, unvaccinated, followed by a mother and infant of another
family sent to sick asylum. Disease afterwards developed; baby was unvaccinated and died. Other
cases were: mother of first case, 36 years, mild, two faint vaccination marks, and two daughters aged
7 and 4 years, both unvaccinated; father of second case, 30 years; brother of second case, 4
vears, unvaccinated ; and sister of second case, 6 years, unvaccinated. Two other children in the house,
aged 11 years and 8 years, had been vaccinated and escaped the disease."