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4
About the middle of May this second prevalence in Southwark was practically at an end,
but there was then a considerable outbreak (14 cases being notified within four or five days) at
Bow-chambers, Poplar. Here again the system of early morning inspections was put in force,
and I)r. Taylor, accompanied by the Council's inspector, Mr. Shapley, kept the inmates of the
house under daily observation; only three cases were later notified from these premises. Between
May 28th and June 4th eleven cases developed at 177, Whitechapel-road, and to this house
Dr. Taylor and the Council's inspector now devoted special attention. The epidemic during May
and June became notably less widespread, and with cessation of the 177, Whitechapel-road
prevalence, on June 22nd, may be said to have come to an end.
A few cases had been notified from Rowton-house, King s-cross, and there was a further
group of cases at these premises in July. No case, however, was reported from a registered
common lodging-house between June 25th and August 16th. On that last-named date a man
at 177, Whitechapel-road developed smallpox, and a further case occurred at the same house
on August 22nd.
On May 26th Dr. Smith was asked to visit the common lodging-houses in Southwark at
less frequent intervals; his visits were soon after further reduced in number, and finally discontinued
; Dr. Taylor's last visit was made rather more than a fortnight after the termination of
the outbreak at 177, Whitechapel-road.
The distribution of cases of the disease among large and small houses.
There were at the time of the outbreak upwards of 500 registered common lodging-houses
in London, capable of accommodating some 28,000 lodgers. Many of the houses were " associated
houses," day rooms and yards being used in common by the occupants of premises which adjoin
one another, but appeared at that time in the Council's records under distinct registered numbers.
Again, there were some 20 or 30 institutions receiving from 3,000 to 4,000 inmates of the common
lodging-house class which were not at the time of the epidemic on the Council's register. For
the purpose of examination of the behaviour of smallpox the associated houses may be regarded,
in each instance, as constituting a single house, and the 20 or 30 institutions above referred to
ma}' be treated as if they had actually been registered. It then transpires that there were—
(a) 18 houses each accommodating some 250 lodgers and upwards, representing a
total population of rather more than 6,000 persons.
(b) 23 houses each accommodating approximately 200 lodgers, representing a total
population of about 4,600 persons.
(c) 90 houses each accommodating approximately 100 lodgers, representing a total
population of about 9,000 persons.
(d) 196 houses each accommodating a small number of lodgers, representing a total
population of about 9,000 persons.
To group (a) belong 325 of the cases of smallpox, i.e., there were in this group 54 attacks
„ (b) „ 141 „ „ „ „ 30 per 1,000
„ (c) „ 147 „ „ „ 16 f of the
„ (d) „ about 75 ,, ,, „ ,, 8 population.
Some 700 cases occurred in the total population of 28,000, i.e., about 25 per thousand.
Only one house in group (a) entirely escaped, and an attack rate of 1 in 50 was
exceeded in 80 per cent, of the houses in this group.
Only two houses in group (6) entirely escaped, and an attack rate of 1 in 50 was
exceeded in 40 per cent, of the houses.
Fifty houses in group (c) entirely escaped, and an attack rate of 1 in 50 was exceeded
in 20 per cent, of the houses.
More than half the houses in group (d) entirely escaped, and an attack rate of 1 in 50
was exceeded in only 10 per cent, of the houses.
It will be seen, therefore, that the incidence upon large houses has been quite disproportionate,
and clearly the aggregation of numbers of lodgers in large common lodging-houses
constitutes a source of special danger when an outbreak of smallpox is in question. It might be
thought that the size of dormitories was of importance in this connection, but in the recent outbreak,
as will be seen later, the tendency of the disease to spread in sleeping rooms has been less
marked than might perhaps have been anticipated.
The distribution of cases occurring among common lodging-houses in different parts of London.
If tlie common lodging-houses be grouped according to the metropolitan boroughs in which
they are situate, it transpires that—
Stepney, with some 6,000 persons belonging to the common lodging-house class,
furnished 309 cases.
Southwark, with some 4,000 persons belonging to the common lodging-house class,
furnished 122 cases.
Westminster, with some 1,800 persons belonging to the common lodging-house class,
furnished 98 cases.
Holborn, with some 2,000 persons belonging to the common lodging-house class,
furnished 79 cases.
Poplar, with some 1,500 persons belonging to the common lodging-house class,
furnished 37 cases.