View report page

15
In view of the recrudescence of smallpox in London at the present time the recent
behaviour of this disease in foreign cities is of interest, notably the prevalence of smallpox in the
Indian cities of Calcutta and Bombay. In Calcutta, in 1895, 1,500 persons died from smallpox,
after which the disease declined; but in 1900 the number of deaths was 900. In Bombay there
was considerable mortality in 1895 and 1896, and again in 1899 and 1900, the number of deaths
in the last year being 3,000. There was also prevalence of the disease in these years in Cairo.
In the foreign cities mentioned in the preceding table, during the last five years only in
St. Petersburg has there been prevalence in each of these years, but in 1900 there was prevalence
in Paris, causing some 200 deaths. While there are no indications of wide-spread prevalence of
smallpox in Europe generally at the present time, there are reasons for believing that
greater prevalence of smallpox in London than that in recent years may be expected for
some time to come. The diagram already referred to (diagram IV.) shows the amount
of prevalence of the disease during the last six completed decennia. In the years immediately
antecedent to 1841 London, however, had suffered severely from small-pox, as nearly 4,000 persons
died from this disease in 1838 in a population of 1¾ millions. It is probable that that year was the
crest of a great epidemic wave previous to the wave which culminated in 1871, when the
death-rate actually exceeded that of 1838. The interval between 1838 and 1871 is one of
thirty-three years, and since 1871 a like period approaches completion. Should, therefore,
there be widely-extended prevalence of small-pox in London it should be remembered that
in certain important respects the population is more favourably situated in respect of risk of
exposure to small-pox infection than in that year. As the result of Mr. W. H. Power's observations
on the distribution of small-pox in the neighbourhood of the small-pox hospitals in
London this large cause of infection has been removed from the metropolis, since the year
1885, when the hospital ships, " Atlas" and " Endymion," which had replaced the " Dreadnought
" at Greenwich, were removed to Long Reach, fifteen miles below London. Subsequent
to 1885 the only small-pox hospital capable of exercising in London the influence
which Mr. Power had demonstrated was that situated at Highgate, and this hospital has
now been removed from London. In 1879 the Metropolitan Asylums Board obtained powers
to establish an ambulance service, and in 1889 the notification of cases of infectious disease
was made obligatory in London. To what extent these changes will reduce prevalence cannot
be estimated, but that they will largely do so there cannot be doubt. While there is much
reason for thinking that the natural behaviour of small-pox will largely govern the prevalence
of the disease, and that increased prevalence may for some time be expected, there is no
ground for anticipating that it will attain such proportions as occurred in 1871. The behaviour
of small-pox in 1900 undoubtedly suggests increase of infectivity, and the following resume
of the cases in that year supplies evidence of a considerable ability of the disease to spread.
During the year 86 persons were certified to be suffering from small-pox. In 13 of these
cases, subsequent examination led to the conclusion that there had been an error in diagnosis,
and in at least 5 of these 13 cases the disease was thought to be chicken-pox. In one other case
the diagnosis of small-pox was regarded as doubtful. The report of the Statistical Committee of
the Metropolitan Asylums Board states that 94 patients alleged to be suffering from small-pox
were received at the South Wharf, of whom 64 were considered to be actually suffering from
that disease. London had been nearly free from small-pox during the last six months of 1899.
With the exception of two cases infected abroad, which occurred in November, the only other cases
which occurred during the six months were 8 patients in the Eastern Hospital who were attacked
in December, and the first of which was a man who had been infected on the way from Jerusalem
to London via Paris. The nature of this man's illness had not at first been recognised, and hence
he was admitted into the Eastern Hospital instead of being removed out of London to the hospital
ships. The occurrences of smallpox in 1900 were as follow—
January—A boy, aged 7 years, suffered from a mild attack of small-pox in a house in a
street less than two hundred yards from the Eastern Hospital in which the cases of smallpox
of the previous month had occurred ; this child, the nature of whose illness was not at
first recognised, attended a party on Christmas and Boxing days in a neighbouring street,
and among the guests was a child living in Bethnal-green who subsequently suffered from
small-pox, which was recognised. The fact was communicated to the medical officer of health
of Hackney, who found the boy aged 7, just mentioned, to be " marked with scars and a few
crusts of eruption, of undoubted small-pox." He also found the father and mother of this boy
and his two brothers to be suffering from small-pox. Three cases occurred in the house in
which the party was given, as well as other cases in Hackney and Bethnal-green, making, in
connection with this group in January, 14 cases in 6 houses situated in Hackney, Bethnalgreen
and Shoreditch.
Other cases which occurred during the month were—An engineer in the Port of London,
who contracted disease from a fireman who had been infected in Bombay. A man, aged 22,
who contracted small-pox on the homeward voyage from Buenos Ayres. A carpenter in
Fulham who had been employed in erecting a small-pox hospital in Hull; a lodger in the
same house as the preceding case. The wife of a man in St. George, Hanover-square, who
had been employed in the erection of the small-pox hospital in Hull, and who had returned
with " a few spots on him." A young man who was attacked with small-pox in the Eastern
Hospital, to which he had been removed on account of an attack of scarlet fever.
February—A case in Fulham, traceable to the case of the carpenter infected in Hull. A
case in Poplar, a sister of one of the cases included in the Hackney group. A woman in
Woolwich, whose mother had died a week previously from " blood poisoning," and whose
illness it is conceivable was small-pox; a sister of the preceding case, who lived in another
house in Woolwich.