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Marylebone, with some 1,250 persons belonging to the common lodging-house class,
furnished 32 cases.
The remaining boroughs, with some 12,000 persons belonging to the common
lodging-house class, furnished 107 cases.
Greenwich, Hampstead, Lewisham, and Paddington escaped altogether; these boroughs,
however, contain only a small common lodging-house population. More noteworthy is the fact
that—
Islington, with some 1,200 persons of this class, contributed 5 cases only.
Kensington, with some 1,000 persons of this class, contributed 8 cases only.
Woolwich, with some 800 persons of this class, contributed 4 cases only.
In these three boroughs there are groups of common lodging-houses with a considerable
aggregate population, but no one house of large size.
It may be of interest to note in connection with the relative immunity of Kensington and
Woolwich that there is a good deal of intercommunication between common lodging-houses in
those two districts and on the other hand but little interchange of lodgers between houses situated
in them and the Stepney and Southwark houses. Moreover, the Council's inspector, Mr. Shapley,
finds that the age distribution of the men in Woolwich differed markedly from that of men in
the Stepney houses. The Woolwich houses, too, contain a considerable tramp population, and
both AVoolwich and Kensington suffered to a notable extent during the prevalence of smallpox
among tramps in 1893.
It will be seen that the six boroughs which stand first, in respect of number of persons
accommodated in common lodging-houses, also stand first in respect of number of cases of smallpox
affecting such persons. Stepney presents numerous instances of large houses, nearly all of
which were attacked ; in Southwark one large house and in AArestminster two large houses contributed
largely to the number of cases ; in Holborn the number of large houses is less in
proportion and cases were more generally distributed ; two large houses, one in Poplar and one
in Marylebone, notably contributed to the cases in those boroughs.
Incidence of the disease upon sex,
About 120 cases occurred among the women, who numbered approximately 2,500 (4.8 per
cent.), as compared with 660 cases among the 25,000 men (2.6 per cent.). The incidence upon
women was thus nearly twice as great as upon men. It may be noted that whereas 89 women
(inmates of common lodging-houses) had been attacked up to the 8th March, 1902, only 16 attacks
among women of this class occurred after that date. Thus, in its inception, the outbreak, so far as
the common lodging-house population was concerned, was in considerable measure entitled to be
described as a women's outbreak. Again, no fewer than 85 of the attacks occurring among women
must be allocated to Stepney, and it may be noted that in this borough there are some 800 female
inmates of common lodging-houses. It may be mentioned that of the 800 Stepney women about
250 were at the time of their attack using accommodation supplied far "doubles" in lodginghouses.
Among users of such accommodation in Stepney 18 cases were notified, 13 in women and
5 in men ; in only one instance was it noted that subsequent to the attack of one of the two
persons constituting a sight, perhaps, somewhat surprising, is in agreement with other facts, which show that only a
small proportion of the occupants of common lodging-houses in London are susceptible, at any
rate under the ordinary conditions of exposure, to infection by smallpox.
The extent to which infection has been transmitted in common lodging-house dormitories.
This question has been made the subject of careful inquiry. Messrs. Garner, Kershaw,
Shapley, and Lightfoot, four of the Council's inspectors, have collected all the particulars on the
matter' it was possible to ascertain in respect of common lodging-houses visited by them ;
the ground covered includes the large majority of the common lodging-houses, in which
several persons were attacked, and in which evidence of infection having been transmitted
in dormitories might therefore be expected to have been forthcoming. Broadly speaking,
spread of the disease in this manner has only been observed in a few instances. In
numerous cases smallpox has developed in several different parts of the house, but a tendency
to be limited to occupants of particular sleeping rooms has been little marked. In
all, full particulars have been ascertained with regard to 300 cases of the disease, and out of
this number in only 28 instances was there any reasonable ground for suspecting that infection
had been communicated in the dormitory. Seven of these cases must be regarded as very
doubtful, having regard to the existence of other possible sources of infection, owing to prevalence
of smallpox in the neighbourhood, among the patients' friends, or in the common
lodging-house itself, or again to such considerations as the position of the bed occupied by the
person first attacked in relation to that occupied by the supposed secondary case. To this last
consideration importance may be attached, because in the majority of instances in which the
evidence under other heads was of a fairly conclusive character it was the rule to find that
the bed of the supposed secondary case was in close proximity to that of the original sufferer.
The annexed table shows, for each of the 28 instances referred to, the length of time
elapsing between the development of the eruption in the primary case and the removal of the
patient to hospital, and also indicates the time of development in relation to these dates of the
eruption in the supposed secondary case.