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until the occurrence of the Kensington cases led the medical officer of health of that district
to direct the attention of his colleague in Shoreditch to the case in the latter district. The
history of this occurrence briefly told is as follows—In Shoreditch a married woman suffered
from smallpox, at first unrecognised ; she was attended by her mother, a resident in Kensington,
who sickened in that district, and who was in turn nursed by two other married daughters,
both of whom were attacked. The son of one of these daughters and the husband of the
other were later attacked, and subsequently a friend who had lived in another house, but who
bad been in contact with two of the infected women. The inmates of this house were
re-vaccinated, and no further case occurred,
Fulham—In the beginning of February two cases of smallpox occurred in different houses
in the Margravine ward. The source of infection of these cases was not apparent, but on
February 12th a district visitor directed attention to several cases of illness in a house in
Greyhound-road. These persons, it was found, had recently suffered from smallpox. The first
case was a man who, in the latter part of the previous December, had been employed at the
Nottingham Borough Smallpox Hospital in Basford, and who, though strongly advised by
the medical superintendent to be re-vaccinated, had positively refused. On the ground floor
lived a brother and sister, who kept a small sweetstuff shop, both of whom were suffering from
smallpox, the girl attending to the shop with the disease upon her. In the basement was a
man and his wife; the former had been attacked about four days previously, and the latter had
just recovered from smallpox. Eleven cases of smallpox were due to infection from this house.
The report contains a useful table showing the relation of these and other cases of smallpox
to each other whenever the connection could be established.
Marylebone—In the six months ending June 30th, only five cases of smallpox had been
notified, but the medical officer of health reports that " in July, however, a fatal case occurred
in Portland Town, under circumstances which, in the first place, absolutely precluded removal
to hospital, and in the second place, gave unusual facilities for its dissemination. An outbreak
of almost unprecedented character occurred in the immediate locality of the case mentioned,
the remote effects of which are even now experienced. This outbreak commenced on
July 3rd, when four cases were notified, and during the seven days from the 23rd to the 31st,
no less than 139 cases from a limited area were removed to hospital. After that date
scattered cases only were reported until August 10th, when there was a smaller but still a
serious burst in and around Nightingale-street. The cause of this was satisfactorily traced to
infection derived from Portland Town, which had smouldered in Nightingale-street. In other
words, cases in Nightingale-street that had not been reported were found to have existed from
July 25th up to August 11th. By the end of August 71 cases had been reported in connection
with this second outbreak. After August, smallpox declined. In September there
were 26 cases; in October, 10; in November, 11 ; and in December, 10. . . . Hence,
of the 299 cases reported during the year, the majority of these were derived from the large
outbreak in Portland Town and the subsidiary outbreak in Nightingale-street, and they fell
for the most part in the months of July and August. The deaths from smallpox amounted
to 29, or about 10 per cent. of the attacks The influence of vaccination and
vaccination in modifying or preventing attacks, and in diminishing mortality, was strikingly
shown. An inspection of the schools also proved that there was a large number of scholars
in the affected areas who had either never been vaccinated or had not been efficiently vaccinated.
In the Portland Town outbreak a local office was temporarily used as a centre to
which messages could be sent, and at which the inspectors and the medical officer of health were
in more or less constant attendance. Similarly, in the Nightingale-street outbreak, a local
administrative centre was established at the Stone-yard. The facilities which this system gave
were so great that the experiment in similar circumstances will certainly be repeated. It
was also found useful to employ special medical aid in visiting from house to house, so as to
discover cases which would otherwise be unreported. Dr. Carter, who undertook this duty,
did as a fact discover a few cases which, had they been neglected, might have formed fresh
centres. The great lesson, however, which these outbreaks teach, is the absolute necessity
for prompt removal to hospital. The very fact that the outbreaks were due to cases kept at
home proves the services which the admirable ambulance organization of the Asylums Board
confers on the metropolis, and shows clearly that if every case of smallpox was early diagnosed
and removed no spread of the disease would be possible. The officers of the sanitary
and disinfecting departments worked well and for long hours, and they were thanked by the
vestry for their services. The guardians also rendered most efficient help in giving facilities
for re-vaccination and in appointing special officers to aid the public vaccinator, Dr. Greenwood,
whose personal assistance was most valuable, and who for a time may be said to have
lived in the affected area."
St. Giles—Whereas in the preceding year nearly one-third of the cases were removed
from the casual and receiving wards of the workhouse and the common lodging houses, in 1894
not a single case was notified from them.
St. Luke—The source of infection in three instances was a child who was suffering from
a rash, which at the time was erroneously thought to be chicken-pox, and no precautions
were therefore taken to prevent the spread of the disease.
Shoreditch—The report of the medical officer of health contains a well-arranged table
giving the particulars of cases of smallpox in the district and their relation to each other.
Special reference is made in the report to a group of cases due, in the first instance, to the
attack by smallpox of a pawnbroker's assistant, whose illness, owing to its mildnesa, had
escaped observation. This case was followed by the attack of three other assistants, two of
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