View report page

contracted small-pox during this epidemic. It is true they were all vaccinated early in October,
but they had opportunities of acquiring infection even before this date, since there were a
considerable number of cases from other parts of London passing through the wharf. This
immunity, however, speaks as much for the efficiency of vaccination and re-vaccination as for
the improbability of aërial diffusion.
During 1901 there passed through the wharf 1,630 small-pox patients, and during the present
year up to July 26th, 6,886. At the height of the epidemic the ambulances frequently came
very close one after another, as many as four or five arriving at the wharf at the same time.
Still, there does not appear to have been any more cases in this area at the time the epidemic
was at its worst in London.
The attack rate per house in this area was 5.03 per cent., as compared with 1.27 per cent, for
the whole Borough, and 2.03 in an area of the same size as that taken round the wharf, with
Wolseley Buildings as centre, but with the number of houses 1,724, and the population 13,792.
The attack rate, including all cases, per thousand of population in the wharf area, was 10.55, as
compared with 2.30 for the whole Borough, and 5.35 for the Wolseley Buildings area.
In Table VI. will be seen particulars of all cases which occurred in the area between October,
1901, and September 6th, 1902. It will be seen that of the 27 cases, the number of primary
cases is 17, and these gave rise to 10 secondary cases. As to the origin of the primary cases, six
had more or less definite connection with the wharf, and these in their turn gave rise to six
secondary cases, thus making a total of twelve. Of the eleven remaining primary cases, there
is a possible origin in five, and there is no trace of the source of infection in six.
Some of the cases in Rotherhithe may be explained in this way. Most of the ambulances go
to the wharf by the New Dock Road. There is a bridge on this road over the canal joining two
of the largest docks, and it is very often opened to let ships pass, just as ambulances and other
vehicles are coming up. I have frequently seen two or three ambulances stopped in this way,
standing in the midst of other vehicles. One doctor informed me he has seen people from a 'bus
which was drawn up close opposite an ambulance, putting their heads out to try and see into
the interior of the ambulance. I have no doubt that infection in some of the cases has been
acquired in this way.
I have dealt so far with the ordinary inhabitants in this area. I now come to what I might
call the day inhabitants, namely those employed in this quarter-mile area, in various yards and
places. Of course a good many employees are inhabitants in this area, but a considerable
proportion, probably at least a half, come from other parts of the Borough outside this, or
from Deptford, Poplar, and elsewhere. I have caused enquiry to be made in these yards, of
which there are 16, employing 703 men. Among these there only occurred three cases of small-pox,
one of which is case I. of Table VI. The other two were in a wharf north of South Wharf.
One of the patients lived in Poplar, where he may have become infected, and the other lived in
the borough, outside the quarter-mile area, and was probably infected by the Poplar man with
whom he worked.
The Master of the Surrey Commercial Dock Pier, which is next pier to the Metropolitan
Asylums Board's Wharf, became infected on February 3rd, 1902. He lived in Balham, so that
obviously he may not have been infected here at all, or if he was, it was by coming in contact
with some of the men from the ambulance ships, who, I am told, were in the habit of frequently
landing at this pier.
Lastly, the Metropolitan Asylums Board were engaged from September last year to May of the
present extending their buildings at the South Wharf. The average day gang was 100 and the
night gang 35, but on one occasion the day gang was 140 and the night gang 50. Among these
temporary employees, who were not subject to compulsory re-vaccination, and all of whom, it will
be admitted, worked very close to the source of infection, only two contracted small-pox. The
first one, H. H., of Hackney, was removed to hospital, February 27th, 1902. The second, C. H. J.,
of Edmonton, was removed on June 1st, 1902.
The latter of these men worked two months at the wharf before becoming infected.
It will be noticed that neither of these dates, nor that of the Pier Master, corresponds with a
probable infection from the accumulation of cases during the fogs.
Be it noted that in dealing with this part of the subject I have dealt with facts, and have
given an account of every individual case as far as I could ascertain the circumstances. I have
not formed any theory first and seen if the facts bore it out.
It is not safe to draw dogmatic conclusions from so few facts, but a due consideration of those
set out here would seem to warrant the opinion that the wharf is accountable for a considerable
number of cases in the quarter-of-a-mile area under consideration.
I do not think the connection between these cases find the wharf can be explained by aerial
diffusion. If it were possible to trace all the movements of the patients in regard to the wharf
employees and small-pox ambulances from the tenth to fifteenth day before they took ill, and
also to trace the movements of all persons connected with the wharf and the ambulance steamers,
I think it is possible that the origin of infection in the cases unaccounted for could be found. I
would not feel justified in making the wharf account for all the cases in this region, but I
cannot help feeling that a considerable share of the prevalence is due to its presence.
The corollary to this is that any accumulation of small-pox patients in a thickly populated
neighbourhood may be a source of danger to the inhabitants unless the hospital and ambulance
arrangements are managed on very strict lines, so as to prevent all inter-communication between
persons employed in that hospital and the surrounding inhabitants. The facts set out here
show, I certainly think, that the danger is to be looked for in this direction, and not through
aërial diffusion of the infection.
In the case of the South Wharf the men from the ambulance steamers should not be allowed
to land when and where they please.