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hours of the morning by the Council s medical officer of health and Mr. Wynter Blyth. The
woman E. W. was actually encountered by a common lodging-house keeper on the 17th and handed
over to a police-constable, but she again escaped. At length, on the 18th, the deputy at 8 and 10,
Parker-street (a common lodging-house for women), acting upon instructions given by the
Council s inspector, caused E. W., who applied for a bed at that house, to be again handed over to
a police-constable, and this time the patient was removed to hospital.
During the five days when she was at large E. W. appears to have infected a number of
persons. After the lapse of a time which would correspond with the incubation period of the
disease, four women at 8 and 10, Parker-street, two women at 2-8, Kennedy-court, two women at
25, Stanhope-street, and two women at 14 and 15, Whitehorse-yard, all houses at which E. W. was
well known, developed smallpox. Simultaneously two men at 29, Vere-street, a man at 4,
Greville-street, two men at 104, Harmood-street, and a woman at Hanbury-street sickened with
this disease. Nos. 29, Vere-street and 4, Greville-street are in the near neighbourhood cf the group
of women's houses involved ; Harmood-street and Hanbury-street are far removed in point of
distance, but there are grounds for associating the Harmood-street cases, at any rate, with the
Holborn cases. In further succession to this batch of secondary infections, a series of cases
occurred at 104, Harmood-street, at Fullwood's-rents, and at 4, Greville-street, and a first case
(probably infected by one or other of the cases belonging to this batch) occurred at 20-25, Queen-
street, a house accommodating men, and was succeeded by a somewhat prolonged succession of
cases in that house. The Hanbury-street case, too, was followed by a series of further cases, other
women s houses in Whitechapel were involved, and from these still other houses were later
infected.
In connection with the Holborn outbreak, as it may perhaps be termed, the Council's
medical officer at once instituted the system of endeavouring as far as possible to keep together
the inmates of infected houses; in particular, persons occupying the same bedroom as the sufferers
were kept under daily observation, and where necessary (to prevent migration to other lodginghouses)
their beds, and in some instances their food, were provided at the cost of the Council. At
one of the houses early implicated the Council's inspector was able to secure the vaccination of
practically all the inmates, but in most cases no considerable measure of success in the matter of
vaccination could be obtained.
At 8 and 10, Parker-street there seemed to be special reasons for concluding that E. W.'s
influence had been operative. Several women concerning whom suspicion had arisen had been
isolated at these premises, and four actual cases of smallpox were notified. There appeared to
be ground for assuming that there would be great difficulty in keping the remaining women (some
of whom might be developing the disease) under observation in the house. It was decided on the
2nd November to quarantine all the occupants, and the subsequent history of smallpox at these
premises will later be further referred to in connection with the consideration of the practicability
of the enforcement of the quarantine system in dealing with smallpox " contacts."
The outbreak had hitherto, so far as common lodging-houses were concerned, been in the
main a Holborn outbreak, though already in October a prevalence, which later assumed considerable
dimensions, had commenced at Rowton House, Hammersmith ; and, as previously mentioned,
a case had occurred at a shelter (Hanbury-street) in Whitechapel, a locality which was subsequently
severely attacked. During November and December the Rowton House outbreak ran its
course: several cases were contributed, too, at this time by houses which had been already infected
in Holborn ; a house in Queen-street, Seven Dials, in particular may be specially referred to in
this connection : furthermore, important new developments in the concluding months of 1901
were the involvement of certain women's houses in Southwark and the extension of the disease in
Stepney.
Hitherto the cases had mainly affected the districts of two of the inspectors of common lodginghouses,
those of Messrs. Garner and Kershaw, and these two inspectors made daily visits to all houses
specially under suspicion, and were thus able to detect many of the cases of illness on the first
manifestation of symptoms, and to secure their isolation until one of the Council's medical officers,
or the poor-law medical officer, could reach the house. In case of necessity steps were then taken
by the inspectors for securing the removal of the patient. In instances in which it was necessary
to ensure the continued residence in the house of a lodger who was unable to pay for his bed, the
inspector had been instructed to make the necessary arrangements, and in those cases in which
the lodger was under suspicion of suffering from smallpox in its initial stages, or in which it was
desirable that particular inmates of the house should be kept under special observation (generally
not leaving the premises) the inspector paid for such lodger's food and bed during the period of
his detention. For example, at 104, Harmood-street four lodgers were thus isolated, at an early
stage of their illness, by the inspector ; at 22-25, Queen-street six lodgers were isolated, and their
speedy removal was secured ; the keeper's wife at a common lodging-house at Rathbone-place, five
lodgers at Fullwood's-rents, two lodgers at 4, Greville-street, and two lodgers at 14, Whitehorseyard,
were similarly isolated and dealt with by the Council's officers; at 29 and 30, Yere-street
the inspector of the district, Mr. Garner, had already at this date isolated 11 cases (later other
cases were isolated by him at this house), and early in Janunry the same inspector picked out
eleven men, at 33, Great Peter-street, whom he regarded as possible subjects of the disease. These
men were at once isolated, and eight of them duly developed smallpox.
When the Southwark group of houses became involved, the Council's inspectors, Messrs.
Wheaton and Gibb, proceeded on similar lines, and in a report to the Committee of January 16th
the medical officer referred to six particular occasions on which the removal of patients had been
expedited by them in Southwark, including instances in which the patients were isolated at the
verv commencement of symptoms by the inspector, and were thus prevented from spreading infection
during the period before the case could be certified. In Southwark this work was greatly