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I do not think there can be any reasonable doubt that all these people suffsred from typhus, and
there must have been ample opportunity for the communication of infectious disease from one to another
among persons so intimately related.
The occurrence of the series of cases of typhus in Bermondsey, of which account is given above,
makes it necessary that I should revert to the past behaviour of typhus in this part of London during
the time which, as county medical officer of health, I have had an opportunity of observing it. It will be
convenient for this purpose to refer to the several reports I have presented on this subject. In reference
to the year 1889, I reported as follows—
In the month of October of 1889, I was asked by the medical officer of health of St. Olave to see
with him some cases of illness in a narrow ill-ventilated court in that district called Sard's-rents. This
court was inhabited by a number of poor people who were engaged in the pulling out of hair from skins.
A disease characterised by pneumonic symptoms and delirium had been prevalent among these people
since January 1st, 1888. One had been removed in March, 1889, to a public institution, and died there,
the death being registered as due to pneumonia. Another had in August been removed to a general
hospital, where he died, the death being recorded as due to bronchitis and emphysema.
In October, when my attention was directed to the occurrence, I saw in the first instance only certain
children who were recovering, and no precise opinion could be formed as to the nature of the illness.
A few days later other persons sickened and were carefully examined by Dr. Wightwick, the medical
officer of health, and myself. Such examination taught us that the disease was not pneumonia, and
although we could discover no eruption on the skin of the patients, their general appearance, and indeed
the behaviour of the disease in the court generally, raised suspicion that it would eventually prove to be
typhus. I visited the general hospital referred to, and was permitted to see the recorded history of the
man who had died in that institution, and this impression being strengthened, arrangements were made
for the removal of subsequent cases to hospital, where the disease was definitely recognised as typhus.
From that time every person subsequently attacked in Sard's-rents was removed to hospital and the
houses disinfected. The outbreak speedily terminated in that locality, and later some of the houses
were demolished under Torrens' Act. Dr. Wightwick estimates that from 30 to 50 persons altogether,
many of whom were children, must have been attacked in Sard's-rents, and certainly 10 people were
attacked subsequent to my first visit.
In November the disease appeared in Yauban-street, Bermondsey, and in that month and the
following, eight cases occurred in two houses. Inquiry into possible relation between the Vauban-street
and Sard's-rents led to the fact being ascertained that the first of the Vauban-street people who suffered
from this disease was a relative of some of the Sard's-rents people, and had nursed them during their
illness.
The introduction of the disease into Yauban-street in 1889 was followed by some extension
of the disease in 1890, but its main prevalence was in the neighbourhood of Dockhead. Coneerning
the cases of typhus in Bermondsey in 1890, I thus reported—
One case occurred in January, in Yauban-street, Bermondsey, doubtless belonging to the group
already mentioned. Prom March to June there was a localised outbreak in the same parish, the first of
a series being a boy living in Gedling-street, Dockhead, who was removed to hospital on the 29th March.
Careful inquiry was made as to the source of infection, and particularly as to whether he had been in
relation with any of the Sard's-rents or Vauban-street cases, but without any evidence being obtained
as to this having taken place. The boy's illness had been previously certified to be enteric fever. It
was followed a month later by a second case in the same house, a girl whose illness was certified to be
enteric fever, but which proved to be typhus. This girl had frequent communication with a boy and
girl in another house in the same street, and a month after her removal to hospital they were also
removed. Their illness was certified to be typhoid, but was afterwards recognized as typhus. Three
weeks later a third member of this last family was certified to be suffering from typhoid fever, but on
removal to hospital was found to have typhus, and two days later a fourth member of the family was
certified to have typhus, the first of this series whose disease was recognized in the first instance. All
were removed to hospital. Besides these, while this outbreak in Gedling-street was in progress, two
young children, members of the same family as that last mentioned, were removed to the St. Olave's
workhouse, where they subsequently developed typhus.
The outbreak ended here so far as can be known, for only one other case, a doubtful one not related
to the preceding, occurred in Bermondsey, in another street, during December.
The only record I have of typhus in Bermondsey in 1891 suggests a fresh importation from
Rotherhithe. The facts as to this occurrence I stated as follows—
In October four children in Bermondsey were admitted into a hospital of the Metropolitan Asylums
Board suffering from typhus, their illness had been certified to be scarlet fever. An elder sister of
these children, I learn from Dr. Dixon, of Bermondsey, had been staying in a house in Rotherhithe
from which a lad had, in October, been removed to a general hospital. The nature of the youth's illness
was not very obvious, and it was first thought he might be suffering from enteric fever, but later his
symptoms raised question as to the accuracy of this view. Information I have obtained from this
hospital makes it likely that the lad's illness was typhus. This is the most Jprobable cause of the
infection of this family. Inquiry into this case was made by Dr. Shaw of Itotherhithe, but no information
has been obtained as to how the lad was infected.
Two cases, however, occurred in the neighbouring district of St. George-the-Martyr. A
carman and his son, resident in a house in that district, were certified in August, 1891, to be suffering
from scarlet fever. They were removed to hospital, where their illness was recognised to be typhus.
During 1892 there was no evidence of typhus existing in Bermondsey, but two women, the
nature of whose illness was not recognised until after their removal to hospital, were found to be
suffering from typhus in different houses in Rotherhithe. Later, a second case of this disease was
removed from each of these houses, and later still two other cases from these houses and two other
cases from another house in the same street. In December of that year a rag sorter in Bermondsey
was proved to be suffering from the same disease.
In 1893 no case of typhus is known to have occurred in any of the districts mentioned, but in
1894 an ice cream vendor suffered from this disease in Bermondsey, and three cases occurred in
Rotherhithe, a man, who was a casual labourer, and his son in October, and a boy in December,
who lived in the same street as the other two cases. In 1895 and 1896 these districts were, so far as
is known, free from typhus, and in 1897 only one case was recorded, that of a boy in Bermondsey who