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17
Smallpox, after having attained a maximum prevalence in March, 1902, had declined
steadily throughout the summer, and during the concluding months of the year only a few cases
—not exceeding ten in any particular week—were notified.
In the first fourteen weeks of 1903 the disease continued at this low ebb in London, the
largest number of cases notified in any one week not exceeding five. During this period
smallpox was prevalent to a much more considerable extent in some of the large provincial
towns ; thus, 4,200 cases of the disease were notified up to and including April 25th from these
large towns—with an aggregate population of some 14½ millions—while only 74 cases were
notified during the same period in London. It is not surprising to find, therefore, that the
information forthcoming as to the cases notified shows that infection was repeatedly imported
into London from various parts of the country, and it was also introduced from time to time
from abroad.
A large common lodging-house, Victoria Home, in Stepney, became involved in January,
this house being one which had been attacked in the preceding year, but the disease did not
spread to any considerable extent. Two cases were notified from this house on 29th January,
one in a " billposter," the other in a man who had been " walking round with the unemployed ";
both these men were unvaccinated. Close watch was kept upon the house, and early morning
visits were made, with the object of examining the lodgers, by the Council's officers. Only one
further patient was removed—on 17th February—from Victoria Home, though one other case,
that of a man found dead on 3rd March, on the pavement in Wentworth-street was also possibly
infected by lodgers from that house; this death was returned at the inquest as due to " hæmorrhagic
smallpox."
The wife of a keeper of a seamen's lodging-house and a man who had tramped in from
a common lodging-house in Essex were also attacked during the early weeks of the year. In
March one of the cases notified was that of a man who had been travelling about the country
with horses, and who had recently come from Maidstone to Battersea, thence to Peterboro',
Norton, Bromley, Romford, Gravesend, and the St. Olave's Union Casual Ward, from which lastnamed
place he was removed to hospital with smallpox.
In the week ending 18th April, an increase in the weekly number of cases notified
occurred, and double figures were in each week the rule rather than the exception throughout
the summer months. During April and May several cases occurred in West, North-West, and
Soutli-West London, in connection with which there arose the suspicion that infection had beeu
contracted in one or other of the villages or towns on the roads leading from the west country
into London ; in particular, persons who had tramped into London from Chertsey, Croydon,
Miteham, Uxbridge, Kingston and Wallington, and several of whom had been engaged in fruit
and flower selling, may be referred to as having probably introduced infection into a common
lodging-house in Surrey lane, Battersea, into one in Kilburn-lane, and into two or three common
lodging-houses and tenement houses in Notting-dale, Kensington, while Rowton House, Vauxhail,
in which a number of cases occurred during May or June, was also probably, in the first
instance, infected from this same source.
In May and June a localised outbreak of the disease occurred among persons living in
certain streets in the north of Poplar, and infection in upwards of a score of instances was traced
to an original case of the disease affecting a patient who had contracted smallpox while in
Bath. This man returned to London on 18th April from the Mineral Water Hospital at Bath,
where cases of smallpox had occurred. He went to the London Hospital on 20th April, and
was then informed that he was suffering from smallpox, but during the temporary absence of the
medical attendant he escaped. I sent at once to each medical officer of health a description of
this man, and on the following day Dr. Alexander informed me that the patient had been removed
from an address in Poplar. In other instances it transpired that infection had been introduced
from Harrow, from Kent, and from Northampton. Another case notified was that of a man
who had been working at a smallpox hospital in Dublin, and two others who were attacked had
been employed in the erection of a temporary smallpox hospital in Durham, which was in
proximity to a hospital containing smallpox convalescents. Later in the year infection was
traced in particular instances to Wiltshire, to Cardiff, and to Russia. During June a case was
removed from a common lodging-house, 16 and 17, Dorset-street, another from 112, High-street,
Deptford, and one from 12 and 14, Gray-street, Lambeth. Careful watch was kept on these
houses by the Council's inspectors, and during May and June Dr. Priestley had under close
observation the inmates of Rowton House, Vauxhall, in which over 20 cases occurred.
As noted in 1902, though to a less extent than in that year, confusion between chicken-pox
and smallpox not infrequently occurred, and, as in 1902, it was frequently found that
the most considerable prevalences of disease were those which were the outcome of failure to
recognise the fact that smallpox was in question. Smallpox was mistaken for typhus in at least
one instance, again, a patient is reported to have been for a fortnight treated for ringworm
by a medical practitioner, and in mimerous instances attacks of smallpox were traceable to individuals
who had had a few spots of which they thought nothing.
In at least one case infection was traced to a visit to the hospital ships, the patient when
there having refused to be revaccinated ; in two or three instances it was supposed by the
patient that infection was contracted in an out-patient room or in an omnibus where he or she
had sat next to some person unknown who had an eruption upon the face. In one instance
the belief was confidently entertained that the disease was contracted at the Lord Mayor's Show.
Attacks among disinfectors and others in the employ of borough councils were not a
marked feature of the smallpox of 1903, as had been the case in the preceding year; a veterinary
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