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bled. On the 20th he continued sick, complained of headache and was delirious. On the 21st his
temperature was 100°, and a swelling appeared over the sternum and an eruption was found over
his chest, abdomen and upper part of his thighs. On the 22nd, when he was seen by Mr. Cantlie,
the medical officer of health of Lewisham and the Council's medical officer, his morning temperature
was normal, his tongue white and moist and the eruption was fading. He had a swelling
over the sternum. Mr. Cantlie was of opinion that the illness was a mild attack of typhus and
that it was unnecessary to send material to Dr. Klein. The source of infection could not be
discovered.
On the 2nd November the medical officer of health of Wandsworth reported that he had
been informed that a young man named L., living in Hobertson-street, Clapham, was suffering
from illness with glandular enlargement, and asked that Mr. Cantlie should visit the patient.
Mr. Cantlie, with the Council's medical officer, saw him the same day and found him suffering
from orchitis. Mr. Cantlie did not think bacteriological examination was necessary.
On the 11th November Mr. Cantlie called on the Council's medical officer and stated that
he had been informed that a man named M., a patient in the West London Hospital, Hammersmith,
but usually living at Barrett's-cottages, Strou'd-green, was suspected to be suffering from
plague. This man had been employed on a tug which towed lighters down from Brentford Gas
Works and up from Beckton Gas Works, and lighters loaded with timber and boards from the
Surrey Commercial and Millwall Docks up to Brentford. Three weeks before this date he had
fallen and struck his back on an iron casing. He subsequently suffered from headache, pain
above the hip joint and in the axilla. Since the 6th November he had been worse, and when seen
by Mr. Cantlie and the Council's medical officer on the night of the 11th November, he had a temperature
of 101°, with swelling of the inguinal glands of both sides. Bacteriological examination
by Dr. Klein of gland juice and of blood taken from this case proved entirely negative.
On the 9th December Sir Hugh Beevor supplied information that a nurse had died at
St. John's House, Norfolk-street, Strand. She had been engaged in nursing a case of acute
rheumatism at a restaurant in the Strand, and the house was infested with rats. She became
ill on the 4th; on the 5th she felt sick and had headache; on the 6th was no better and thought
she had influenza; on the 7th was considerably worse, and had a faint rash on the upper part
of the chest; on the 8th was evidently going to die, the skin of the chest and abdomen had
become darker, and she died next day. The body was removed to the mortuary and a postmortem
examination made at 4 p.m. on the 9th, Drs. Klein, Hamer, Young, and Allan, the
medical officer of health of Westminster, being present. The body was found to be covered
with a purpuric eruption, which was especially marked in a triangular area included between
a transverse line drawn through the umbilicus and bounded below by two lines drawn across
the front of the thighs parallel to and a few inches below Poupart's ligament. There were
haemorrhages in the conjunctivæ and petechiæ in the pericardium, the pericardial sac containing
several ounces of blood. The appearances were consistent with those of hæmorrhagic smallpox.
There had been a number of cases of smallpox in the neighbourhood, and she had been in
contact with other nurses who had been on the smallpox hospital ships. Bacteriological examination
by Dr. Klein proved negative, so far as plague was concerned.
Thus, in each of the above cases, examination led to the conclusion that the patient had
not suffered from plague.
In my last report I stated that under the arrangements made in London for dealing with
any cases of plague which might occur in London the duty of providing for actual cases of this
disease devolved upon the Metropolitan Asylums Board, that of providing for persons in contact
with cases of plague upon the London County Council. In the first instance it was arranged
that the Council should receive into their shelters persons who presented symptoms of plague
for such time as was necessary to determine the nature of the malady from which they were
actually suffering, but later it was agreed that the Metropolitan Asylums Board should
receive suspected cases of plague. In February the Public Health Committee presented to the
Council an estimate for providing accommodation for 1,000 persons in 200 families. This
accommodation was divided into three classes (a) that which should be ready at the moment
when required, (b) that which could be got ready in a few hours, and (c) that which could be
got ready in a few weeks. The first would make provision for 212 persons, the second for 200
and the third for 600. The estimate for this provision was £50,000, but it was only proposed
to expend some portion of this immediately in repairs to and furnishing of buildings already
in possession of the Council, in the acquisition of certain buildings, including a laundry, and in
preliminary expenses for foundations, water supply and drainage of further buildings on land
belonging to the Council, and in provision of clothing for the persons removed to the shelters.
Steps were taken to repair and furnish the buildings in possession of the Council and to provide
clothing, but it was not found necessary to proceed further with this scheme, the Committee
having ascertained that various premises in London could be obtained if necessary in consideration
of the payment of a small annual retaining fee to the proprietors. These houses
would accommodate 670 persons, and the retaining fee was £200 per annum, the total rent
payable if all this accommodation was required at the same time being less than £200 per week.
The Council on the recommendation of the Committee decided that arrangements should be
made with the proprietors for this purpose.
In April the Public Health Committee reported to the Council the steps which would be
taken in the event of any person in London presenting symptoms which raised suspicion of
plague. The report was as follows—
We reported to the Council on the 2nd instant the result of a conference with representatives
of the Metropolitan Asylums Board on the subject of the method of dealing with suspected cases of
plague in London, and the Council passed the following resolution—
That the Local Government Board be informed that the Council is willing that the Metropolitan