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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.
During the following January, five other inmates of the Workhouse
and three members of the Workhouse staff were removed to hospital
suffering from small-pox.
During February and March no cases of small-pox were notified
in the home district, possibly owing to the extreme care that was
taken in dealing with tramps both at the workhouse and in the
common lodging-houses, as there can be no doubt that at this
period the infection was very widely spread amongst the tramp
population in London and elsewhere. The disease re-appeared,
however, in April, and during May, June, and July, scattered cases
were brought to light amongst the general population. In no
instance, however, was an initial case allowed to become a centre of
infection, owing to the prompt measures of isolation, re-vaccination,
and disinfection undertaken on the receipt of a notification of the
disease.
Altogether in the Home district 18 cases have been notified,
viz.: 5 cases of casuals from the Workhouse ; 3 cases amongst the
Workhouse staff; one case, a lunatic inmate of the Infirmary (September)
; 2 cases of inmates of a common lodging-house in Churchstreet
; and 7 cases amongst the general population.
Four cases, notified as small-pox, were subsequently found to
have been the subjects of a mistaken diagnosis. Two of them
developed measles, and one was a case of chicken-pox.
In Kensal Town, the first case of the year—that of a tramp in a
common lodging-house—was notified in March. Six cases amongst
the general population were notified in April and in June—one of
them being the Vestry's disinfector. During the following four
months—July to October—Kensal Town remained free of the
disease. In November, however, 10 cases were notified, these forming
part of the North Kensington outbreak, on which I had the
honour to present reports to the Vestry on November 14th and
28th. One case was notified late in December ; its connection with
the North Kensington outbreak being well established.
THE NOTIFICATION OF INFECTIOUS DISEASES.
Small-Pox.—In London during 1893, 2,933 cases of this disease
were notified, as against only 436 cases in 1892. The greatest
prevalence was, as usual, in the spring, the outbreak reaching its
maximum in May, when some 500 cases were removed to the
small-pox hospital ships. Not one of the London parishes escaped
the disease altogether, which shows its wide diffusion over the
whole area of the metropolis. In the early part of the year the
epidemic was largely confined to the class of vagrants, casuals, and
tramps. The difficulty—already sufficiently great—of dealing with
infectious diseases occurring amongst this nomadic class of the
population, is becoming enhanced in London by the increasing provision
of huge charitable shelters, accommodating under the same
roof many hundreds of homeless individuals. The introduction of