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18
SMALL-POX.
There was no death in the borough from small-pox (the corrected decennial average number
being 0 9) nor had there been any death from this cause in the six preceding years. Five cases
were notified. In London 87 cases were notified, against 104, 32, and 29 in the three preceding
years : 66 cases were admitted to hospital; four deaths were registered, three in hospital, the
corrected decennial average being 45. During the ten preceding years the deaths aggregated
431 only, the numbers being 4, 8, 41, 206, 88, 55, 9, 16, 1 and 3 in the successive years.
Local outbreak in Kensington. The five cases notified had a common origin. The facts
of the outbreak are here stated in the order of their occurrence, relating as they do to two groups
of two and three cases in the borough, and to other groups in other districts, owning the same source
of infection; viz., an unrecognized case which occurred in a flat at a block of residential buildings
in Westminster, in the person of Mr. D., the valet, whose wife was housekeeper to the occupier.
This man fell ill on or about April 30th, the date of infection, from an unknown source, being
approximately April 16th. The disease was thought to be measles, the certified cause of the death,
which took place May 9th. Mr. D.'s son, an innkeeper's manager at Wolverhampton, attended the
funeral on May 11th. He was in town again May 24th, and returned home May 25th, being then
very ill. His complaint was diagnosed as Eczema; but when his child, his servant, and his nurse
subsequently fell ill, it was recognised that all the four had small-pox. The servant, whose illness led
to discovery of the outbreak, had left the inn before she developed small-pox. The nurse also fell
ill after leaving the inn. This information, supplied late in June by the innkeeper's sister, Mrs. A.
(the illness of whose children will be hereafter referred to), was subsequently confirmed by the local
medical officer of health.*
Mrs. D., the valet's widow, was so mentally upset by her husband's death that it became
necessary, on Thursday, May 10th, to place her in the observation ward at St. George's infirmary,
Fulham-road, whence she was discharged on Wednesday, May 16th—but not before (by her clothing)
she had conveyed the infection of small-pox to a ward attendant, who was removed to hospital on
Wednesday, May 23rd. Mrs. D. went direct to a tenement occupied by her step-daughter, Mrs. A.,
in Barker-street, a narrow cul-de-sac in South Kensington. On Thursday, May 17th, she went to
her late home, and that of her deceased husband, in Westminster, to get her clothing, which was
taken to her step-daughter's abode in Barker-street, where she remained until Friday, May 18th,
on which day she removed to her brother's house in Chelsea—being ill at the time. On Monday,
May 21st, the medical officer of health of Chelsea reported that Mrs. D. was suffering from small-pox
in the fifth day of illness : Thursday, May 17th, therefore, being the approximate date of attack.
Observation was thenceforth kept of the Kensington family, comprising Mr. and Mrs. A.
and their four young children, all of whom had been vaccinated. On Tuesday, May 29th, one of
the children, Amy A., aged 10 years, fell ill. On Wednesday she was seen by a doctor, who
thought the symptoms "suspicious." Next day when I saw the child the rash of small-pox was
out, and she was removed to hospital forthwith. A second child, Muriel A., aged 8 years, was
removed on Friday, June 1st, on the third day of illness. There can be little doubt that these children
had been infected by their step-grandmother's clothing. The house was disinfected, and it was
hoped that the outbreak was at an end: and so it appeared to be, for no other case occurred at the
house, or at the infirmary, or at the house in Chelsea, or elsewhere, traceable to infection conveyed
through Mrs. D.
But on Monday, June 11th, a notification of small-pox was received from a house at
Western-terrace, Notting-hill, in the person of Jessie M., aged 19 years, an employee at a
Chiswick laundry. Five doctors had seen her; three thought the disease was chicken-pox and
did not notify; the fourth notified "? small-pox," the fifth notified small-pox. The patient was
not ill, in the common acceptation of the word, when I saw her (on the 11th). The rash
indicated the eighth day of disease, and though neither extensive nor very characteristic, I
formed the opinion that it was a case of small-pox, and certified for her removal to hospital.
Enquiry disclosed the fact that a companion employee at the laundry (Harriet W.) living at
Queen's-park, Chelsea, was ill and had a rash. With her doctor and the medical officer of health
of Chelsea, I saw the case. The rash was smaller in quantity than in Jessie M., and even less
characteristic. The conclusion arrived at, in agreement with the views of four or five other
doctors who had seen the patient, was that it was a case of chicken-pox. My Chelsea colleague
immediately afterwards saw Jessie M. with me, and thought the rash suspicious; but as the
family occupied the whole house, and the patient was unwilling to go to hospital, as a precautionary
measure, she remained at home under observation.
I reported these two cases to the laundry company, whose manager called upon me on
June 12th, and stated that two other employees, one at Queen's-park and one at Fulham, were
*This gentleman wrote:—"A club met weekly, at the inn, whose manager (son of the deceased valet) was ill, in an
upstairs room facing his bedroom, and the members used to sit on his bed and chat with him ; good testimony as to the
value of copious lathering with zinc ointment applied in the treatment of supposed eczema by the nurse who died from
hemorrhagic small-pox." Probably vaccination might reasonably be credited as the cause of the guests' immunity.