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committed to my superintendence—but it was worth recalling as a standard of comparison with the
then current epidemic. It served also to illustrate the immense progress, since 1871, in regard to
hospital accommodation, ambulance service, etc., and to show the reduction in mortality, largely
due to notification and the removal of the sick out of London. The report was as follows:—
" Small-pox, which had been prevalent in a malignant form on the Continent during the
Franco-German War, spread to London in the autumn of 1870, and during the fourth quarter
was accountable for 584 deaths, including five in Kensington. In 1871 the deaths in the
Metropolis from this cause were 7,876—2,400, 3,241, 1,255, and 980, in the four quarters respectively;
in England and Wales 23,000. The fatal cases in London in 1872, numbered
1,781—831, 582, 237, and 131, in the successive quarters. In 1873 the deaths were 115,
including one in Kensington. The population of London in 1871 was 3,254,260; the smallpox
death-rate 2.4 per 1,000. Hospital accommodation available, or improvised during the
epidemic, was inadequate—how inadequate will be understood when it is stated that only
2,856 (=36.2 per cent.) of the deaths took place at these institutions; 2,415 of them at the
Asylums Board hospitals at Hampstead, Stockwell, and Homerton. The patients admitted
to these hospitals in 1871 numbered 12,840; the case-mortality was slightly under 19 per
cent. Assuming the same rate of mortality at the minor hospitals, at which 441 deaths
occurred, the total cases in London can hardly have been fewer than 42,000, of which only
36 per cent. were isolated in hospitals. Had London suffered in the same proportion during
1902—regard being had to increase of population—the attacks would have been some 60,000.
"In Kensington, in 1871, the estimated number of cases was 610; the recorded cases 444;
the concealed cases approximately 166. Three hundred patients were removed to hospital, of
whom 58 died, a case-mortality of 19.3 per cent. The deaths at home were 62; total deaths,
120. The largest number of reported cases was in May and June—91 and 116 respectively;
343 cases were recorded in the first half of the year; 101 in the second; 302 belonged to
North Kensington, 142 to South Kensington; 89 and 31 being the respective number of deaths
in the two divisions of the parish; 104 of the deceased had previously resided in the Town
sub-district, only 16 in the Brompton sub-district; of the 236 males attacked 62 died; the
female cases were 208, the deaths 58. These figures necessarily take no account of concealed
cases.
" The disease appeared in 179 streets, &c.; 323 houses were invaded. In 256 houses there
was one case to each; the case having been reported in good time, the premises disinfected,
and the inmates re-vaccinated, there was no spread. In 40 houses there were 2 cases each;
in 13 houses 3 cases; in 5 houses 4 cases; in 7 houses 5 cases; in 2 houses 7 cases. In several
instances all the cases occurred before the existence of the disease became known; not seldom
though the occurrence of a death. *
" Admittance to the hospitals of the Asylums Board in the far-off days of 1871 was nominally
restricted to persons in receipt of 'relief,' and was obtainable (in most districts) only
by an order signed by the relieving officer, or the master of a workhouse, on the certificate of
the ' parish doctor.' Nevertheless, the bulk of the patients were ' non-paupers,' the legal
restrictions (notably in Kensington) having been wisely relaxed. Now, the hospitals are free
to all, the sole condition precedent to admittance being the production of a medical certificate.
In 1871 the hospitals were in London. Now, all patients are removed to the ships
and the land hospitals out of London. Then, sick people often refused isolation; now, practically
all avail themselves of the advantages offered by the hospitals. Hence the need for
accommodation on a large scale; but, as it turned out, not to the extent provided. In 1871
the sick were generally removed in vehicles of a more or less unsatisfactory description,
provided by the Guardians, and often driven by paupers, assisted by pauper ' nurses.' Practically
no supervision was exercised, and the ambulances and their attendants were not infrequently
responsible for the spread of disease. Now, the ambulance service provided by the
Asylums Board, and whether by land or by water, leaves nothing to be desired.
" Among the means now at the disposal of the Sanitary Authorities, enabling them to
exercise effective control over infectious disease, the first place is held by Notification, the
necessity for which had been urged in my annual report for 1871 (pages 15-16). This allimportant
measure did not become operative in the Metropolis until 1889, despite the efforts
of the sanitary authorities to obtain it, and which, under the lead of the late Vestry, date
back to 1881.
" A word must be said about Vaccination, which is still controlled by the Poor Law
Authority. Efforts are being made to transfer the control to the 29 sanitary authorities.
Personally, I am still of the same opinion as in 1877, when (in the annual report, page 15)
I recommended transfer of the execution of the Vaccination Acts to the hospital authority—
as did the Royal Commission in 1882. That infant vaccination was much neglected in 1871
was made evident by the fact that 46 (=38.3 per cent.) of the 120 deaths in Kensington
were of children under five years of age, including 15 less than one year old. The statistics
published in my report for 1871 (pages 17-19) furnish satisfactory evidence of the protective
influence of vaccination and re-vaccination. It is all the more gratifying therefore to know
that there is not in London a better vaccinated population than that of Kensington."
* Full details with regard to this remarkable epidemic may be found in the Annual Report for 1871, pages 13-18.