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General Precautionary Measures.—Never before was London so well prepared to deal with
an epidemic, whether regard be had to means of removal and isolation of the sick, or the
diffusion of information as to the occurrence of outbreaks, the names and addresses of contacts, etc.
Through the intermediary of the medical officer of health of the London County Council, there
was daily intercommunication between the borough medical officers of health, which kept each
fully informed of the occurrence of illness in all other districts of the metropolis. The Asylums
Board, moreover, forwarded to each medical officer, daily, a list of deaths and discharges at the
several hospitals; and, weekly, a list of cases admitted, embracing a short history of each,
indicating, where possible, the source of infection.
No case of small-pox in London was removed direct from home to hospital. Every case
was removed, in the first instance, to the South Wharf Shelters at Rotherhithe, and thence—
if found to be suffering from small-pox—to Long Reach. If the case were doubtful it was detained
for observation. If clearly not small-pox, the patient was revaccinated and sent home—information
in such cases being forwarded to the Medical Officer of Health. A few such occurred in the
borough and happily not one of them was the worse for the journey. Medical practitioners were
encouraged by the Asylums Board experts to send doubtful cases to the shelters for diagnosis,
which was the best practicable course, the Board having felt unable to supply the services of an
expert at the patient's home, as I had suggested.
Conclusion.—I thought it desirable at the commencement of the epidemic, which, as we have
seen, was mainly confined to North Kensington, to charge the Chief Sanitary Inspector with the
sole responsibility of carrying out the arrangements designed to prevent the spread of disease, and
it is simple justice to acknowledge that he performed the duty, which included the visitation of
some hundreds of " contacts," by day and night, on week-days and Sundays alike, to my entire
satisfaction, and I may add, with signal success.
A few words will not be out of place here with respect to the extent of the epidemic in London,
as a whole.
The notifications in 1902 were 7,796 (compared with 29, 88, and 1,702, in the three
preceding years), the total for the two epidemic years, 1901-2, being 9,500.
The admissions to hospitals, in 1902, were 8,455, against 1,788 in 1901. Of the admissions
in 1902, 8,088 occurred in the first half of the year.
The deaths in 1902 were 1,314, and exceeded the corrected decennial average by 1,245.
The numbers in the four quarters successively were 734, 506, 73, and 1: 1,240 in the first half of
the year and 74 in the second half.
The ages at death were :—
Under one year 105
1—5 182
5—20 239
20—40 481
40—60 258
60—80 47
80 and upwards 2
The case-mortality, calculated upon notifications, was 16.9 per cent.
At the end of 1901 there were 666 patients under treatment in the hospitals; at the end of
1902 only 14.
The boroughs that suffered most were Holborn, Stepney, Shoreditch, Bethnal Green
and Poplar.
Subsidiary matters relating to the epidemic, including Hospital Accommodation, Ambulance
Service, Vaccination, Notification of Chicken-pox, etc., are dealt with under the several headings.
Here, some further reference may be made to subjects cursorily noticed in the preceding summary.
And firstly as to—
Diagnosis of Doubtful Cases of Small Pox.—The symptoms preceding the appearance of
the rash in vaccinated persons are frequently slight—they decline, moreover, on the outcoming
of the rash, which itself is often small in quantity and so modified, as to present real difficulty
in diagnosis. Even the expert is occasionally puzzled, and would be the last to impute blame
for error where there had been a genuine attempt to arrive at a correct diagnosis. Encouraged
though they were to send doubtful cases to the Asylums Board Shelter—for diagnosis, or as a