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15
The cases in the Shoreditch Workhouse and Infirmary are not included in the
above table. One of these was removed on the second day of illness, and four on the
third day. Two were brought to the infirmary ill, and were removed within 24 hours
of being so brought, and in three instances the histories of invasion were too indefinite
for the day of the disease to be stated with anything like certainty. One case
terminated fatally before removal could be effected, the patient dying within 24 hours
of the onset of symptoms. The cases in the Holbcrn Workhouse are also not
included in the table. With respect to twelve of them, the removals were effected
on the second day of illness, in nine on the third day, in one case on the fourth
day, and in one on the fifth day. One case was removed about the ninth day, but the
history was not quite conclusive as to the day of illness. In three other cases the date
of invasion was not sufficiently definite for the day of the disease to be stated.
According to the foregoing figures, isolation in the majority of cases was effected
on the third, fourth and fifth days of the disease. Of the 352 cases in the table, 29,
or 8.2 per cent. were removed to hospital on or before the second day of illness ;
whilst of 29 eases in the two Poor Law Institutions, concerning which reliable information
as to the day of the disease was obtained, 13, or about 45 per cent., were removed
to hospital during the first two days of illness. This difference is attributable to the
fact that the medical officers of these institutions are able to keep the inmates under
closer observation than is as a rule practicable in private life. I may mention that I
had opportunities, both in private and in the public institutions above referred to, of
seeing cases within a few hours of the onset of symptoms and watching for the
appearance of the eruption. In several cases the eruption was sufficiently characteristic
to warrant a diagnosis- of small-pox twenty-four hours after the illness
commenced, and in a few cases the eruption was sufficiently marked in less than
24 hours to admit of the cases being certified and removed to the hospital as smallpox.
A few observations are necessary respecting the outbreak as it affected the
Shoreditch and the Holborn Union Workhouses. Institutions such as workhouses
are much exposed to the introduction of infection of a disease like small-pox. Owing
to the conditions of life in a workhouse, every case occurring amongst the inmates
becomes naturally a source of anxiety to the officers of the institution, and the most
stringent precautions are always required to prevent the spread of the disease, the
sheet anchors being prompt diagnosis and removal to hospital of the cases, thorough
disinfection, and the early vaccination or re-vaccination of all who, having been
exposed to infection, have not recently undergone the operation.
The cases in the Shoreditch Workhouse and Infirmary numbered 11, excluding
that of the baker to the institution. He did not reside on the premises, and probably
contracted the disease through infection brought from Islington. The first case was
that of a man aged 34, who was admitted to the infirmary from a common lodginghouse
in the neighbourhood on January 13th. The eruption was observed on
the following day, and he was at once removed to hospital. His case was of the