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49
Smallpox.—This complaint did not put in an appearance in the
City until the end of July. It had been prevalent in Glasgow in
the early part of the year, but no cases seemed to have reached
London. It was from Paris that London was infected. There had
been an epidemic during the previous year, and it had continued
into 1901. The first cases in London were persons who had been in
Paris. (Smallpox was introduced into the United States from
Honduras in the spring of 1897, and has been prevalent in North
America since that date.)
During August, September, and October only a few cases occurred
in Westminster, but towards the end of the last-named month a
woman of the lowest class suffering from the disease, in the
neighbouring Borough of Holborn, was going about the neighbourhood
of Clare Market, Drury Lane, visiting numerous public-houses
both in Westminster and Holborn for four days. As a direct result
a very large number of persons were infected, and in every publichouse
into which she had been one or more of the inmates took
smallpox. In a number of the remaining cases the source of
infection was traceable to the same cause, more or less directly.
There were 102 notifications, but 18 of these eventually proved not
to be smallpox. There was in addition one fatal case, which was
not notified until after death. The corrected total was therefore 85,
and 17 of the persons affected died, equal to a mortality ot 20 per cent.;
13persons had never been vaccinated, and of these seven died; it is
very doubtful if six of the 72 remaining cases had been vaccinated at
any time, as there was no visible evidence, and four died. Sixty-seven
persons who had been vaccinated in infancy, more or less successfully,
developed the disease, and six died. The bulk of the cases were
between the ages of 20 and 65, five only being below the age of 20,
the youngest vaccinated person affected being 16 years of age,
showing that the protective effect of infantile vaccination had worn
off to a certain extent. The six deaths occurred at ages 28, 36, 42,
and 47 respectively. If these 67 persons had not been vaccinated
in infancy, 36 of them should have died instead of six, and it must
be remembered that the bulk of these persons were tramps, or
persons in casual employment, already in a debilitated state of
health.
Some of the cases were of the malignant hasmorrhagic form,
asserted by some to be due to the presence of a putrefactive or
septic organism in conjunction with the smallpox. In such cases
the appearances are quite unlike ordinary smallpox, and death
generally takes place, before the eruption appears, from hasmorrhage.
(8545) D