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facilitated by the co-operation of the medical officer of health, Dr. Millsom, who devoted much
personal attention to securing the isolation of suspects and to furthering the carrying out of
vaccination.
To Stepney, which had at first been comparatively free from attack, the main seat of
incidence of the disease had shifted during the last four weeks of 1901 and the earl}' weeks of
1902. The unfortunate escape of a man who was notified from No. 1, Heneage-street, and who
was for three or four days at large, may have contributed in some degree to spread of the disease
in this locality ; the influence exerted by the Hanbury-street shelter and other women's houses
has already been referred to. The Heneage-street house became markedly implicated in
December, when the Hanbury-street outbreak was at its height; in the early part of January
cases occurred at 39, Commercial-street, 117, Whitechapel-road, 106, St. George's-street, 27 and
29, Brick-lane, 50 and 58, Flower and Dean-street, and other common lodging-houses in Stepney.
The night inspector had from the first intimation of the growth of the outbreak in Stepney been
told off to assist the inspector of that district; additional assistance was, moreover, rendered by
other officers, but the involvement of two large houses in Westminster and the continuance of
cases in Southwark made large demands at this time upon the Council's oflicers. Accordingly
early in January the medical officer was authorised to arrange with Dr. Taylor, of Mile End-road,
to make night inspections with a view to the early detection of cases of smallpox.
The experience hitherto gained showed that no fewer than 44 of the cases which had
occurred in common lodging-houses (amounting at this time to about 200 in all) had been detected
and dealt with in the first instance by the Council's officers. Of the 44 cases, 27 were among the
number for whom payments had been made, and the ability to make arrangements for food
and lodging led to a number of persons who were sickening from disease being prevented
from mixing with other lodgers in the kitchens and from migrating to other common lodginghouses,
while in some instances individuals were confined to the house who would otherwise have
gone to work. Three inspectors, Messrs. Garner, Kershaw, and Wheaton, had been hitherto more
particularly engaged in dealing with cases of suspicion. Mr. Kershaw at this juncture unfortunately
resigned, but the medical officer obtained authority to secure the services of additional
inspectors in order that from this time forward Messrs. Garner, Wheaton, and Shapley might
devote the whole of their time to the inspection of the houses invaded by smallpox. It had been
arranged that the services of the medical men on the list of the Council's district officers should
be made available in case of necessity for the purposes of diagnosis. The special circumstances of
Stepney had, as already stated, made it necessary to employ Dr. Taylor to make medical inspections
there ; on the 10th January he had commenced to carry out this duty on alternate nights,
later (February 2nd) authority was given for daily inspection to be undertaken for a time, and
it was then found convenient to make the visits in the early morning rather thau at night as
originally arranged.
At first great difficulty was experienced in persuading lodgers to be vaccinated. On
January 30th, 1902, the Public Health Committee authorised the exhibition in all common lodginghouses
of a notice recommending lodgers, who were not protected against smallpox by recent
vaccination, to submit to the operation. During January and February the difficulties previously
encountered, owing to growing apprehensions excited by the spread of the outbreak, were lessened,
and at a few houses a large proportion of the lodgers were now protected. Thus, at the Burnestreet
Shelter, Dr. Greenwood succeeded on February 1st, with the co-operation of the medical
officer of the Council and the officers of the Salvation Army, in vaccinating 130 men, and later
all the lodgers at this shelter were ivaccinated; the completeness of the results obtained in this
particular instance was in large degree attributable to the attitude adopted by the medical officer
of the district, Mr. Wynter Blyth.
The outbreak at Burne-street just referred to had commenced on January 15th ; the two
Westminster houses involved at the close of 1901 continued during the early weeks of 1902 to
furnish cases, the Yere-street prevalence terminating on March 14th, while that at 33, Great Peterstreet
continued some weeks longer. Stepney meanwhile was the chief source of anxiety. In
addition to houses already mentioned, 35, Dorset-street, 19 and 19½, Brick-lane, and 5, Flower
and Dean-street were now specially attacked. There was, moreover, a sharp outbreak at 217,
Bow-road, Poplar, during February, and about the middle of that month a case occurred at St.
Olave's-chambers, Southwark, and was followed by a group of secondary cases. During March
it became manifest that the epidemic among the general population, having reached its height,
was now on the wane, and this statement also holds good for the common lodging-house population,
though in the latter half of the month cases were still occurring at 33, Great Peter-street, and
a fresh prevalence became established at St. Olave's-chambers. The Stepney cases, however,
markedly diminished in number, although 20-22, Whitechapel-road, a shelter which had suffered
earlier, again became involved.
In April the decline in the number of cases in London as a whole became pronounced; those
occurring in common lodging-houses were not much less numerous than in March, but April,
like March, compared favourablv with February. Towards the end of April and in the early
days of May a considerable outbreak of the disease occurred at St. Olave's-chambers, and on
Mav 2nd the Chairman of the Public Health Committee authorised the employment of a medical
man, Dr. F. W. Smith, to pay visits in the early morning to this Southwark lodging-house, in
the same way as was being already done in the Stepney lodging-houses. The Council's inspector,
Mr. Gibb, accompanied Dr. Smith early each morning to this house, and later to other lolgingliouses
which were attacked ; several cases of smallpox were thus detected at an early stage, and
their removal to hospital was expedited. In Stepney, Dr. Taylor was now inspecting only three
times weekly, there having been a falling off in the number of cases in this district.