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Parker-street (60 lodgers), and at 4, Greville-street (60 lodgers), one-fifth of the total
number were attacked; in 8 other houses (5 of which were houses with .100 beds and
upwards) more than one-tenth of the lodgers suffered. It has been already seen that
an attack rate of one in fifty was exceeded in 80 per cent. of a group comprising the
largest houses, but was only exceeded in 10 per cent. of a group which includes the houses
of least considerable size.
It is noteworthy that even in houses which were situated in specially affected areas,
and in which the disease was again and again introduced, the large majority of the
occupants escaped attack. It appears to be clear, therefore, that in London in 1901-1902
only a small percentage (probably not exceeding 20 per cent.) of the common lodginghouse
population was susceptible to the disease, or at any rate susceptible to infection
under the circumstances of their exposure to it.
The behaviour of smallpox in the larger common lodging-houses will be seen
on reference to the accompanying diagram, which indicates the date of occurrence of
cases in all the houses having some 200 or more inmates in which six or more cases of
smallpox occurred between October 26th, 1901, and June 23rd, 1902.*
The cases belonging to the several common lodging-houses are arranged in this
diagram in a horizontal series, each case occupying a position which corresponds to the
date upon which the rash occurred. Each vertical column represents two days (see dates
given at the head of the columns). The houses are arranged in order of size, the first
three containing some 600 beds each ; then follow five with some 400 beds each, seven
with 300 beds, and nine with 200 beds. Each case is represented by a rectangle, whose
breadth is half that of one of the ruled squares, and whose height is inversely proportionate
to the size of the house to which the case belongs. Thus—
In houses with 200 beds the height is that of 1 of the ruled squares.
,, ,, 300 ,, ,,2/3 ,, ,,
,, ,, 400 ,, ,, ½ ,, ,,
,, ,, 600 ,, ,, 1/3 ,, ,,
The hatched squares represent the extent to which inmates of houses were persuaded
to undergo vaccination, and indicate the time of carrying out such vaccination. If
practically all inmates were vaccinated 20 squares are hatched, if only half the inmates
10 squares, and so on.
(b) As to the cause of the occurrence of a considerable group of cases in a common
lodging-house.
In a few instances groups of 4 or 5, in some instances 9-12, cases (this last-named
number was never exceeded) occurred at particular houses (see the diagram referred to).
In the larger groups in each instance there was unmistakable evidence to the effect that
the persons attacked had been in close association with a man or woman who had
remained at large for several days subsequent to having developed symptoms of smallpox.
The group of 12 cases (common lodging-house L, see diagram) occurred in friends
of a man who sickened on December 24th and developed hemorrhagic smallpox, but who
was not isolated until December 26th. Another considerable group (common lodginghouse
P) was associated with a hemorrhagic case, in which symptoms of illness existed
for four or five days before the disease was diagnosed. Another group (common lodginghouse
T) was associated with a case of confluent smallpox in a man who remained unisolated
for four days after his eruption first appeared.
(c) As to the effect of panic vaccination upon the course of outbreaks in common
lodging-houses.
Such vaccination was performed with completeness in the case of four houses (A, C,
F and W), less completely (more than 50 per cent, of the inmates protected) at two
others (N and P), while in the remainder vaccination of 25 per cent, of the inmates was
in no instance accomplished, though in all of them an appreciable proportion of the
lodgers was vaccinated. Upon the diagram referred to, the relation of the vaccination
in point of time to the occurrence of the cases of smallpox is, as already mentioned,
indicated. At the houses C, P and N, the disease had caused considerable mischief before
the wholesale vaccination of inmates was resorted to. The outbreak came to an end
after the vaccination was carried out, but probably most of the susceptible persons had
then already been infected. At the house W vaccination was resorted to rather earlier,
and no case occurred after its adoption, save one, that of a man who had escaped the
vigilance of those carrying out the vaccination. At the houses A and F the results
obtained were particularly striking. (See Diagram.)
It appears from the reports of the medical officer of health of Hammersmith, Dr.
Collier, that vaccination was performed with completeness at Rowton-house, and its
effect in checking spread of disease there appears to have been marked. Dr. Collier
records, however, that smallpox occurred in a man, Fred. Geo. Kirby, removed on December
20th, 1901, with a modified pustular rash, who had been vaccinated about 17 days
before. Such cases were carefully looked for in the case of inmates of common lodginghouses,
of whom, as will be seen, some thousands living in infected houses were
vaccinated, but no such instance was discovered.
* The particulars with regard to smaller houses were in each instance ascertained, but considerations of
space prohibit their inclusion in this diagram. In a few of these smaller houses there were 6 or more cases of
smallpox.