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eruption of smallpox on 13th October. She was taken to the Endell-street Infirmary on the 15th,
where her disease was recognised, but she escaped before the ambulance arrived. Search was
made for her, and watch maintained in the neighbouring common lodging-houses by the Council's
officers, which were visited in the early hours of the morning by Mr. Wynter 131yth and the
Council's medical officer. On the 17th she was encountered by the keeper of a common lodginghouse,
who handed her over to a police constable, but she again escaped, and it was not until
the 18th inst., when she entered a common lodging-house in Parker-street, that she was
secured and removed to hospital. She was thus, while suffering from smallpox, a source
of considerable risk to other persons during a period of four days, and after the lapse
of time corresponding with the incubation period of smallpox, ten women, who were inmates of
common lodging-houses in Parker-street, Kennedy-court, Stanhope-street and Whitehorse-yard,
were attacked. At all these houses she was well known. At the same time three men in the
neighbouring common lodging-houses in Yere-street and Greville-street were attacked, and two
men in Harmood-street, St. Paneras, were also attacked. Following these, and no doubt
dependent on them, a series of cases occurred in common lodging-houses in Fulwood's-rents and
in Greville-street, Holborn, and a case in a common lodging-house in Queen-street, Drury-lane.
A series of cases also occurred in the Hanbury-street shelter and other common lodging-houses
in Whitechapel. In November and December a series of cases occurred in Rowton House,
Hammersmith, and in November a series occurred among ihe inmates of common lodging-houses
for women in Southwark.
The appearance of cases in the common lodging-liouse population of Holborn led to two
courses of action being taken by the County Council. The occurrence of four cases among the
inmates of the Parker-street common lodging-house, as already stated, made it appear probable
that other inmates of the house were incubating the disease, and inasmuch as at this time the
common lodging-house population had not been largely involved, the Public Health Committee
determined to take every possible step to limit its spread amongst people of this class. Arrangements
were therefore made with the keeper that the Council should rent all the beds in the house,
and should make a small allowance for food for all the inmates who consented to remain in the
house. To this house, moreover, were removed certain inmates of other common lodging-houses
in the neighbourhood who had been especially exposed to smallpox. This system of quarantine
was maintained for three weeks, the lodgers, with rare exceptions, consenting willingly to the
conditions imposed. It was only at a later date, however, that the disease reappeared in this
house. The other course of action which was at once adopted and maintained during the outbreak,
was the daily inspection of the inmates of invaded houses by the Council's inspectors,
with a view to ascertaining whether any of the inmates were manifesting signs of illness, in which
case one of the Council's medical officers was immediately sent for. Further, when smallpox
occurred in a common lodging-house, every effort was made to ensure that those exposed to
infection should continue to reside in the same house until the period of incubation had elapsed,
and the privilege of a free bed, and, in a number of instances, small sums for food, were offered
in cases in which, without such inducement, it would have been impossible to retain particular
lodgers under observation. As a result, in numerous instances it was found possible to separate
persons who were beginning to sicken with smallpox from the other inmates, and retain them
in a different room from those occupied by the other lodgers until the circumstances warranted
their removal to hospital.
The history of smallpox occurrences during the latter part of the year pointed to the
frequency with which there was mistake in the diagnosis of smallpox. Cases of this disease
were in a number of instances due to infection from persons whose illness had been regarded
as chicken-pox, and hence chicken-pox was in 1901 added to the list of diseases required to be
notified in St. Paneras, Hampstead, Holborn, Bethnal-green and Greenwich. The London
County Council at the beginning of 1902 made an Order which required the notification of
chicken-pox throughout the whole of London, and also made arrangements by which the services
of medical men familiar with smallpox were made available for the purposes of diagnosis.
On the 25th September the Local Government Board addressed a circular letter to the
metropolitan borough councils, calling attention to the increase of smallpox in London, and
stating that the Board attached very great importance to the most energetic measures being
taken in connection with the cases which were occurring, with the view to preventing the
spread of infection, and asking that the medical officer of health should be instructed to visit
every house in which the disease had broken out, and at the earliest possible moment to
take such measures as might be necessary to secure, as far as practicable, the isolation of the
patient, the vaccination of any persons who may have been exposed to infection, and the disinfection
of the premises, and any further action which the circumstances would admit of for the
purpose of checking the extension of the disease. The Board enclosed copies of a memorandum
on the steps specially requisite to be taken in places in which smallpox was prevalent. At the
same time the Local Government Board addressed a circular letter to Boards of Guardians,
asking that the attention of the Boards of Guardians should be at once specially given to the
state of vaccination of all children or other persons who may not have been vaccinated, and to
the promotion of revaccination among adolescents and adults. The attention of the boards of
guardians were directed to the Article of the Vaccination Order of 1898, requiring them to ascertain
that the vaccination officer was performing the duties imposed upon him and that he should, on
hearing of importation of smallpox, immediately make inquiries (if need be from house to house)
as to vaccination throughout the locality, and that in addition to seeing that children illegally
unvaccinated are vaccinated he should impress on the parents of all unvaccinated children the
extreme danger of delaying vaccination. The Board promised their immediate attention to any