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Smallpox and Vaccination.
Smallpox, which caused 1 death in London in 1889, 3 in 1890, and 8 in 1891, caused 29 deaths
in 1892.
During each of the seven years 1886-92 the death-rates were below the mean rate of 1851-92.

During the years immediately antecedent to 1892 a comparatively small number of cases of this
disease were notified to the medical officers of health in London. The returns of the Metropolitan
Asylums Board supply the following number of cases of smallpox notified in London since the passing
of the Infectious Diseases (Notification) Act, 1889—
Year. Cases notified.
1890 60
1891 114
1892 425
The recent history of smallpox in London has been as follows:—In the early part of the
year 1891 cases of smallpox had occurred among the riverside population. A ship's steward
who had been exposed to smallpox in Lisbon suffered from this disease in Limehouse; a grain
porter who had been working on board ships in the Surrey Commercial Docks sickened at
Greenwich; a dock labourer employed in unloading corn from a vessel on the Thames sickened at
Rotherhithe; the child of a man casually employed in the Millwall Docks sickened at Poplar; other
cases occurred later in Greenwich and Bermondsey among people engaged in connection with shipping,
and a man who had recently come from Swanage sickened in St. Giles. Some of these cases led to the
infection of other persons. In the latter part of the year a number of Swiss waiters employed in a
house in St. Pancras were attacked, leading to cases of smallpox in that district and in Marylebone.
During the year 1891 cases occurred in Limehouse, Greenwich, Rotherhithe, St. Giles, Bermondsey,
Bethnal-green, Camberwell, Mile-end, Shoreditch, Kensington, City, Islington, Lambeth, Lewisham,
Marylebone, St. Pancras and Wandsworth.
In the beginning of the year 1892 four cases of smallpox associated with the outbreak among the
Swiss waiters in the latter part of 1891, also occurred. The most notable outbreak in the year
occurred in Shoreditch, the particulars of which were supplied me by Dr. Allan, at that time medical officer
of health of that district. The first case appears to have been a child living in New Inn-street, whose
illness was regarded as chickenpox. This child was away from school on account of this illness during
the week ended 7th February. An adult living in the same house suffered from so-called chickenpox
on February 20th. A brother of the girl worked in Curtain-road, and although he did not himself
suffer he appears to have conveyed infection to others, who in their turn served as sources of infection.
In this manner the disease rapidly spread to neighbouring streets, as many as 83 cases occurring in the
district during the year, and others resulting from them in the neighbouring districts of St. Luke,
Bethnal-green, Hackney, Holborn, Islington, and Whitechapel. The medical officer of health of
Kensington reports that four cases of smallpox occurred in one house in that district, the first in the
person of a medical man who had been exposed to infection at hospital, and the nature of whose illness
was not recognised. Three other members of his family were infected by him.