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(d) As to difficulties in securing the prompt isolation of lodgers with a view to
preventing spread of disease.
This matter has already been more than once commented upon. Thus, the fact
that where groups of cases have occurred they have been traced to unisolated sufferers
from smallpox has been noted, while, on the other hand, over and over again in the course
of the outbreak instances have been forthcoming in which, isolation having been promptly
secured, the disease has not spread. Again, the evidence adduced, in this connection,
with regard to the liability of occasional occurrence of second cases in the dormitory
occupied by the original sufferer, if that sufferer were not promptly removed to hospital,
sufficiently indicates the importance of early isolation. Under the system that has been
put in practice, in the case of common-lodging houses, persons who have complained of
being ill, or who have been singled out by deputies, etc., or by the Council's officers,
because they presented evidence of illness, have been carefully watched and removed as
soon as a diagnosis could be made, but it has not been practicable to cope successfully
with the difficulties presented by cases in which the sufferer has abstained from making
complaint and has succeeded in evading observation. The mischief caused by such
persons has been considerable. At 33, Great Peter-street a concealed case gave rise to
a group of secondary cases; these were all promptly isolated by the Council's inspector,
but infection was re-introduced into the house, on more than one occasion, by men who,
though suffering from the disease, managed to keep out of the way until they had infected
others. At 20-25, Queen-street the same experience was forthcoming; cases were isolated
with promptitude, but from time to time infection was re-introduced by individuals
who succeeded in evading notice during the early days of their illness. In some instances
these concealed cases presented very mild forms of the disease, in others the attack was
more severe, but the patient nevertheless continued to attempt to do his daily work up to
the latest possible moment. The discovery of the existence of these concealed cases
involved much work of a quasi-detective character; the Council's inspectors found, for
example, in several cases that lodgers who considered they had "only a beer rash," on
being interviewed, proved to be the subjects of unmistakable smallpox. In some instances
medical attendance was repeatedly declined, and it was only the insistence of the
inspector which brought about the notification of the case.
A system of compulsory daily medical inspection of all common lodging-house
inmates would no doubt have given better results than were actually attained in the
recent outbreak, but such a system would, of course, have involved considerable expense.
The plan actually adopted was not a costly one; it threw, however, a considerable tax
upon the Council's staff, and for a time necessitated the employment of two medical
men, one in Southwark and one in Stepney. The large majority of the inmates of infected
houses were kept under observation, and during January, February, and March, some
30 or 40 houses, several of which were large houses, were daily inspected, approximately
5,000 actual "contacts" being dealt with. The expense incurred (excluding that
involved in quarantining the inmates of 8 and 10, Parker-street, fees paid to Drs. Taylor
and Smith, and the salaries of the Council's own officers) was only £34 14s. Id., or, say,
l¾d. per contact.
The extent to which re-infection of houses occurred after successful early isolation
of the original sufferers was in a few instances very disappointing. Indeed, in groups
of houses situated in localities in which the disease was especially rife, it almost seemed
as if smallpox was not to be prevented from affecting a certain percentage of the inmates,
as if, in fact, it must exhaust, despite all efforts, the susceptible material in the common
lodging-house population. This may be more or less true in particular instances, but
on the whole it may be reasonably claimed that prompt isolation did much to limit
spread of the disease among the common lodging-house population. Still more remarkable
was the extent to which smallpox was confined to inmates of common lodginghouses
and the poorer class of tenement houses, thus failing to obtain any foothold
among the rest of the population of London.
The condition of inmates of common lodging-houses as regards having suffered from previous attach
by smallpox.
It is not possible to state with complete accuracy the extent to which persons occupying
common lodging-houses in London have suffered from smallpox of late years. It was found, however,
on making inquiry into this question—among 1,000 common lodging-house inmates in
Stepney—that of 224 who had so suffered, 79 gave the date of their attack as being prior to 1870,
7G suffered during the years 1870-79, 31 between 1880-89, and 13 from 1890-1901. It may be
roughly assumed that something like 1 in 20 (probably a somewhat larger proportion) of the
common lodging-house population were attacked in the great outbreak of 1870-1, and that in the
smaller outbreaks of 1877, 1881 and 1885 considerable, though smaller, proportions of common
lodging-house inmates (1 in 40, or thereabouts) were affected. From 1886 onwards for several
years there was marked freedom from smallpox in London. At length, in October, 1891, the
disease was introduced among the foreign population living in the neighbourhood of Tottenhamcourt-road,
and later in 1891 and the following year it appears to have been on several occasions
imported by men tramping into London from the provinces. The prevalence of 1893 was notably
favoured by spread of the disease among the vagrant class ; indeed, out of a total of 2,400 cases,
325 occurred among vagrants, 31 being reported from the Blackfriars Shelter, 32 from Burnestreet
Shelter, 14 from Horseferry-road Shelter, 16 from Medland-hall, and 179 from other
common lodging-houses. (See Dr. Long's report to the Metropolitan Asylums Board, 1893.)