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On the 9th September (being the tenth day of the disease) she was seen again by her doctor,
and permitted to return to her " place," being then undoubtedly infectious. Interesting as the
discovery of this case was, it did not account for the others : it was manifest, indeed, that every
one of the five cases had been infected by a still earlier sufferer, who at last was traced in the
person of Charles C., aged 19, son to Mr. C. C. This youth had been employed outside the
borough, but slept at home. At some date between August 11th and August 18th, he was taken
ill, the symptoms being suggestive of small-pox ; in two or three days spots appeared, which
excited the less attention, as his face was usually spotted (with acne). He was advised to see a
doctor and went, but the doctor not being at home he did not repeat the visit. He soon
recovered, and was able to take a situation at another restaurant, in Paddington, where, with
the borough Medical Officer of Health, I saw him on September 14th. There was no doubt that
this was an unrecognised case of small-pox, and the source of infection, firstly of his aunt, Emily
C., then of Emma W., who visited the C. family, and lastly of his sister, his father, and his
stepmother. All necessary steps were taken, by disinfection, vaccination, etc., to prevent the
further spread of the disease, and all known persons who had been exposed to infection were
revaccinated and kept under observation.
Among other cases in the Borough the following may he cited as of interest:—•
John W., aged 20, shop assistant, contracted the disease at an establishment in an
adjacent borough, at which cases of small-pox had occurred. A brother employe brought him
to his own home in Kensington, on November 16th, on the first day of an illness the character
of which was not suspected. On the 19th a rash appeared, but the patient was not seen by a
doctor until the 21st, on which day he was removed to hospital.
Alfred T., aged 21, of uncertain occupation, had slept for some nights at Rowton House,
Hammersmith, before taking up his abode at a common lodging-house in Kensington, where he
fell ill, on or about November 21st: he was removed, on 23rd, to the infirmary with a certificate
of influenza : on the 24th the rash of small-pox developed, and he was sent to hospital forthwith.
Ernest T., aged 17, fishmonger's assistant, fell ill November 23rd, with acute tonsillitis. On
27th a rash appeared, which, on Friday, 29th, was recognised as small-pox, and he was removed
to hospital forthwith. It was ascertained that another youth employed at the same place, but
living in another borough, was ill. The fact was communicated to the Medical Officer of Health,
who found that not only this youth, but his two brothers also, were ill with small-pox ; dating
from about November 2(ilh. The source of infection in these four cases (probably the same) was
not ascertained. The Kensington case (unvaccinated) proved fatal : the other three cases
i(vaccinated) were mild, and made speedy recovery.
Robert W., aged 24, a carpenter, fell ill December 13th; the rash appeared on 15th
and he was removed to hospital by his doctor on 16th. The source of infection was not traced.
'The patient spent the week end—November 30th to December 2nd—including the infection date,
at Stepney, in which borough numerous cases had occurred.
Maggie M., aged 47, married, bed maker at Rowton House, Hammersmith, where numerous
cases had occurred, was seen on December loth, at Rowton House, by the Medical Officer of
Health of Hammersmith, who " found her with symptoms closely allied to those premonitory to
variola." The house, at Notting Dale, where with her husband she occupied a furnished room,
being visited, she was found to have small-pox, and was removed to hospital forthwith. This
woman stated that, feeling too ill to do her work at Rowton House, on the 15th, she returned
home. Not being ill enough to keep her bed, she went about the house, and even out of doors
between that day and the 17th.
Charles S., aged 19, employed in domestic work, as visiting house-boy, attacked on December
15th, went to his employment up to the 17th, having a rash at that date. He applied for medical
advice at the dispensary, Mary-place, on the 18th, and was removed to hospital forthwith. This
youth had been an inmate of a Boys' Home since December 3rd. Previously to his admission,
and at the time he became infected, he had slept at a casual ward, in another borough,
where cases of small-pox had occurred. The boys at the Home and the inmates of the house
where the patient worked were revaccinated. There was no spread of disease from any of the
above cases.
Precautionary Measures.— The measures to prevent the spread of small-pox adopted at
the commencement of the epidemic, and now practised, are in advance of anything previously
attempted. In former epidemics one of the greatest hindrances to preventive action was the
want of information as to what was going on in adjoining districts. Now, a system of daily
interchange of information has been instituted through the intermediary of the Medical Officer
of Health of the London County Council, who transmits to the Borough Medical Officers, daily,
particulars of all cases reported to him, by those officers, upon a settled plan. The Asylums Board,
moreover, send to each Medical Officer, daily, a list of cases discharged from hospitals; and,
weekly, a history of every case admitted during the preceding seven days. One of the principal
sources of danger being diffusion of infection by inmates of casual wards and common lodginghouses,
the Guardians in this borough arranged for a daily examination of " casuals" bv one of
their district Medical Officers, who offers re-vaccination, whilst the County Council, by their
Public Health Committee and medical and inspecting staff, give particular attention to the common
lodging-houses. At an early period of the epidemic, the disease having appeared at one of
these houses, the premises were rented during the incubation period of fourteen days, the
" contacts " were detained and maintained, the Local Government Board having intimated that,
in the exceptional circumstances, they would be prepared to sanction, tinder the Local Authorities
(Expenses) Act, 1887, the expenditure incurred ; and this course has since been adopted when
necessary. It is hardly requisite to say that in this borough infected houses were disinfected