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In my last aniiual report I gave account of the occurrences of smallpox in London in
1900, the last cases (two domestic servants) occurring in Chelsea and Fulham in November of
that year, and being traceable to the illness of their master who suffered from "blood-poisoning
two days after his return from Paris. It is not yet possible to discuss in any complete manner
the whole of the outbreak which extended into the summer of 1902, but the manner in which
the disease became diffused in London, causing some 1,700 cases in the year, may at once be
stated. From November, 1900, no cases of smallpox are known to have occurred in London until the
week ending the 26th January, 1901, and the following history, for which I am largely indebted to
the reports of medical officers of health and weekly memoranda of the Metropolitan Asylums
Board, contains particulars of the cases up to the time when the disease became general in Loudon.
In that week there were notified two cases, one that of a girl having a Polish name, resident in
Stepney; the other a patient in Kensington, who was incubating the disease at the time of his
return from Paris. No further cases occurred until the week ending the 16th February, when a
case was reported in Wandsworth, that of a steward from a ship on which two cases of smallpox
had occurred during the voyage. Smallpox was not known to have occurred again in London
until the week ending the 30th March, when a woman was attacked in Fulham. Mr. Jackson
states that her husband three weeks before had suffered from smallpox, but that the nature
of his malady had not been recognised. The source of his infection could not be ascertained. The
next case was notified in Bethnal-green in the week ending the 11th May, a domestic servant
who had not left her home for six weeks. Dr. Bate, who saw the patient, regarded the diagnosis
of smallpox as doubtful. No case was subsequently heard of in London until the week
ending the 1st June, when a lady who had just arrived in Islington from Egypt, developed
smallpox. The next case was a child aged three years, in Stepney, whose illness was notified in the
week ending the 15th June; then a nurse in St. Marylebone, notified in the week ending 22nd
June, who appears to have been infected by a young American returning from Paris, and the
nature of whose illness was not at the time recognised. In the next week ending 29th June,
a case was notified in Hackney, a carman who fetched linen from the customers of a laundry.
Up to this date there had been no known extension of the disease from any of the cases of
notified smallpox, but the carman infected three persons in his own family, and a woman who
sorted the linen and who was also attacked, infected two members of her family. The same
week the Hackney carman's case was notified, four cases were notified in Wandsworth. Dr.
Caldwell Smith, having been informed that a Mrs. B., who had been staying in Streatham, had
developed smallpox, instituted inquiry as to the circumstances of this case in London. He
found that she had been infected by a Mr. W., who, after arrival from Paris, had died of unrecognised
smallpox in the house in which she had been staying, and that Mr. W.'s wife had
suffered from "influenza." Another visitor was then removed from the house suffering from
smallpox and a third visitor was found to have suffered near Loughborough from what was
called malignant chicken-pox, and finally two girls who worked in the laundry to which the
linen of this house was sent suffered from smallpox in their homes, together with a third girl
who was infected by one of them. The completeness of the measures taken prevented any
further extension of the disease. In addition to cases belonging to the Hackney and Wandsworth
groups mentioned above, one case was notified in St. Marylebone. The St. Marylebone case was
that of a clerk who, with a servant whose ilness was notified the following week, was
associated with a case in Paddington notified in the week ending the 20th July. Another
case in Paddington notified in the week ending the 20th July was a woman who had arrived
from Texas on the 27th June and who was erroneously thought for some time to be suffering
from enteric fever. In the week ending 27th July there was notified in Hammersmith a woman
employed at the premises of a disinfector at whose works infected articles are disinfected for the
sanitary authorities of Kensington and Chiswick. The inmates of this patient's house were
offered but declined vaccination, and her daughter was attacked the following week and her son a
week later. In the same week as the son's attack (week ending the 3rd August) a woman living
in Westminster, whose husband was a tailor, suffered from smallpox. The source of infection
could not be ascertained. There was also attacked a man in Hackney whose sister lived next
door to the workers at the laundry who were attacked in July. In the following week (ending
the 10th August) a young man was removed from a hotel in St. Marylebone, and a young man
in Wandsworth, who had been infected in Paris.
The history of cases of smallpox in London gave no reason for thinking that up to this
time the steps which had been taken in the several metropolitan boroughs to prevent the general
extension of the disease had not proved sufficient for the purpose, but the occurrence of certain
cases of smallpox in St. Pancras at this time was followed by rapid diffusion of the disease.
Three cases of smallpox were notified in that district on 2nd August. Two of them were those of
women living in a house in Tottenham-street. Their illness, which was recognised at the Middlesex
Hospital to be smallpox, had been preceded by the illness of their sister a fortnight before, her
malady having been thought to be chicken-pox; she was a girl 17 years of age, a sorter of
dirty linen at a laundry received from hotels and boarding-houses in the W.C. district. A
case was also notified in Huntley-street on the 9th August. In the same week the case of a
man living in Portpool-lane, Holborn, was notified. He was believed to have contracted his
disease at a working men's club near the Holborn Town Hall. There were also notified thd
case of a boy in Hackney, who visited on the 28th July the man in Hackney referred to above;
the case of this man's sister and that of a barman in Exeter-street, Strand; also those of a printer
in Finsbury and a printer in Southwark, members of the club in Holborn; also a caretaker in
Hampstead, whose disease was contracted outside the borough, but the source of whose infection
Vas not known.
In the following week (ending the 24th August) the number of cases notified in