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It appears that in none of the cases of suspected dormitory infection was the removal of the
primary case effected before the second day dating from the appearance of the eruption ; in several
of them removal was delayed until the third, fourth, and fifth days after the rash developed,
or even longer. Again, judging by the date of appearance of the rash in the secondary case,
it may be assumed that the mischief caused by the primary case did not, as a rule, become
operative until some short time after the appearance of the eruption, for between the date of
the second eruption and that of the first there was, as a rule, an interval of rather more than
14 times 24 hours. In three instances in which this was not the case (the tenth, fourteenth,
and twenty-sixth in the table) the fact of dormitory infection having occurred at all is doubtful,
and in the remaining instance (the seventh in the table) there is some uncertainty about the dates,
and the time of occurrence of the earlier of the secondary cases is almost certainly antedated.
It seems clear, therefore, that prompt removal of a case of smallpox (within a few hours
of the first appearance of the rash) obviates almost all risk of spread of the disease to persons
who have occupied the same sleeping room as the patient. It had been noted early in the
epidemic, for example, that at 8 and 10, Parker-street such prompt removal of a batch of three
cases was not followed by further cases in those houses, and numbers of similar instances were
later forthcoming. It appears, therefore, that the importance of facilitating removal at the
earliest possible moment can scarcely be over-estimated, and that were it possible in a fairly
well vaccinated population (such as the common lodging-house population) to effect such early
removal in all instances there would be little likelihood of spread of the disease.
Thus, while aggregation of persons in large houses has been seen to have favoured diffusion
of smallpox, the infection has apparently only been disseminated in a very small proportion of
instances in the dormitory. Inquiries made by the inspectors raise the presumption that intercommunication
of lodgers in the common kitchen may occasionally have served to promote
spread of infection, but one of the most common places for acquirement of the disease seems to
have been the bar of the public-house. It has frequently transpired that the secondary cases
occurred in men who were in the habit of drinking with the original sufferer, and potmen and
other persons associated with public-houses have in several instances been attacked at about the
time when cases were occurring in a common lodging-house hard by.
Peculiarities observable as regards incidence upon particular common lodging-houses.
This question may be dealt with under the following heads—
(a) As to the extent of the mischief in those houses which suffered in a specially
notable degree.
The heaviest incidence observed was at a house, 104, Harmood-street, with only some
40 lodgers, in which 10 cases occurred. At 35, Dorset-street (80 lodgers), at 8 and 10,