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London was as many as 22, 18 of which occurred iu St. Paneras. One of these occurred in the
house in Tottenham-street originally invaded. Four cases occurred in the house next door
(No. 44); their illness had been preceded by the death, on the 11th August, of a child from
chicken-pox, in the house in which they lived, this child having been fondled by the two
sisters who were removed from No. 40. The child's sister- lived in fciandwich-street, .and she was
removed on the 19th, and on the 23rd a man in the same house was also removed. He was
brother to one of the four cases removed from Tottenham-street on the 22nd; a child was also
removed on the 23rd from the same house in Sandwich-street. Of the remaining 10 cases in
St. Paneras, two were removed from other houses in Tottenham-street, one, a boy, who was
removed from William-street, knew boys in Tottenham-street, another from Gresse-street, who
played with children in Tottenham-street, another in Pitt-street, a porter who was employed
in a neighbouring restaurant, another a woman in Seaton-street, who worked in a laundry in
Tottenham-street, another a lad, who lived in the neighbouring Whitfield-street, and another
a man living in the neighbouring Charlotte-street. In the same week there were removed from
Foley-street and Little Marylebone-street, both iu St. Marylebone, two cases, the former a child
who had friends in Tottenham-street, the latter a man who worked with the father of two cases
who were removed from Tottenham-street and Sandwich-street respectively. Other cases were
a man in Stoke Newington who worked with a man in Hackney removed on the 2nd August, and
a man who was removed from the St. Marylebone Workhouse on the 24th August. This man
had been living in Barking, and after infection, had been in a common lodging-house in St.
Paneras and subsequently in the Salvation Army Shelter, Bume-street, Marylebone, in both of
which he was resident while in an infectious condition. In the following week (ending the
31st August) there was an outbreak of 25 cases in St. Paneras, and 16 cases (the diagnosis of
4 of which was incorrect) occurred in St. Marylebone. The cases in St. Paneras were apparently
all associated with the outbreak already referred to, and those in St. Marylebone were probably
also associated; they lived in a locality abutting on that in St. Paneras which was invaded, and
in several instances they were acquainted with the invaded families in St. Paneras. Mr. Wynter
Blyth, the medical officer of health of St. Marylebone, writes that his district had been "free
from smallpox for 18 days, but on the 24th August up to the present date [3rd October] a series
of notifications of smallpox have been received, the infection apparently for the most part being
derived from a group of cases which occurred in the neighbouring district of St. Paneras." Dr.
Sykes, the medical officer of health of St. Paneras, referring to the St. Marylebone cases speaks
of them as "not apparently infected from the same source." The same week two cases, a man and
wife, were notified in Islington, infection being received iu Tottenham-street, and a third case, the
source of infection of which is not known. There were also notified a child in Stoke Newington
whose aunt lived in Tuttenhaiji-street and a man in Holborn who kept a butcher's stall in Goodgestreet,
Tottenham-court-road. The infection of a woman in Holborn who shopped in the infected
neighbourhood, of a man in Finsbury who worked near there, and of a man in Wandsworth who
also worked in that neighbourhood, were also probably due to the same centre of infection. It is unnecessary
for the purposes of this report to continue to show the progress of the disease from caso
to case. In the week in question cases of smallpox occurred in nine of the London boroughs, and
gradually spread throughout the county, no single district escaping. The circumstances of smallpox
among the poorest class of the population may, however, be more fully stated. In September
the disease appeared among hop-pickers on a farm near Bodiam, in Sussex, who were no doubt,
from the evidence, infected by a girl from Tliomas-street, Finsbury, who developed her illness
on the farm, but the nature of whose malady was not recognised at the time. A family among
the hop-pickers apparently infected by this girl returned to London suftering from an eruption
on the skin. They were taken to the lloyal Free Hospital, where their illness was recognised
to be smallpox, and the whole circumstances of the outbreak were promptly investigated by Dr.
Newman, the medical officer of health of Finsbury. He found that several of the hop-pickers had
been attacked on the farm with what had been thought to be chicken-pox, and that several
hundreds of persons thus engaged were returning to London. Steps were at once taken for the
inspection of these people as they arrived in the railway stations by the officers of the County
Council and the Finsbury Borough Council, and for the taking of the addresses of persons coming
from the infected farm. Five cases of smallpox were thus detected and removed direct to hospital
from the Cannon-street Station. In other cases the disease appeared after their return home to
London, Dr. Newman stating that in and near Tliomas-street some twenty cases were removed.
Until this time the inmates of common lodging-houses were remarkably free from attack by
smallpox. On the 23rd August, however, a man had been removed from a Salvation Army Shelter
in Bcthnal-green, and on the 8th September another man from the same shelter. Daily inspections
were made of the inmates in consequence. On the 24th August a man was removed from the
Burne-street shelter; on the 19th September a man was attacked who stated he had slept in
casual wards and various common lodging-houses, and on the 3rd October, a man who had slept in
various shelters. In the middle of October this class of the population became more seriously
involved. On the 19th October a man was removed from the St. Marylebone casual ward who
had frequently been in the Burne-street shelter. Mr. Wynter Blyth reported that this man had
walked the streets in the neighbourhood of Covent-garden on the night of the 18th October
while probably delirious, and had passed the day on one of the seats in Regent's-park. Close
watch was, therefore, kept on the inmates of the Burne-street shelter, and on the night of the
1st November the County Council's medical officers inspected 369 persons who occupied bunks in
the shelter, but no case of smallpox was discovered. On the 22nd October a hop-picker from
Barnet was removed from a shelter in Stepney.
The first considerable outbreak affecting the occupants of common lodging-houses occurred
ill Holborn. A woman, who had been engaged in selling walnuts in Covent-garden, had the