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The differences in the case of the two sexes are thus inconsiderable.
Inquiries (a) and (b) point to the conclusion that the percentages of common lodging-house
inmates remaining, after separation of the groups "vaccinated and re-vaccinated "and" attacked
by smallpox, were 23 per cent. females and 32 per cent males. All the persons making up these
percentages, it would appear, had been "once vaccinated." It is probably not far from the truth
to say that at the beginning of the 1901-2 outbreak nearly three-quarters of the common lodginghouse
population had either been "vaccinated and re-vaccinated," or had suffered previously
from smallpox ; again, about one-fourth of the common lodging-house population had merely
been vaccinated in infancy ; finally, a very small percentage indeed were totally unprotected
either by vaccination or previous attack of smallpox.
with a view to obtaining as correct an idea as was possible of the extent to which common
lodging-house inmates were vaccinated during the outbreak, inquiry was made at all the common
lodging-houses in February, 1902, by the Council's inspectors, and further inquiries of a less
complete character were made in April, and at a later date. The number of persons whom the
Council's inspectors had actually seen operated upon* in February, amounted to about 2,000 ; later
reports show that while this number was largely added to it was probably not doubled. In addition,
a number of common lodging-house inmates were vaccinated in workhouses, by public vaccinators,
or again at the instance of philanthropic bodies, etc. Mr. Shapley ascertained in Stepney,
in April, that of 1,000 lodgers, selected at random, 224 had been vaccinated since the commencement
of the epidemic. In September, among 100 men in Woolwich questioned by Mr.
Shapley, only 14 said they had been vaccinated since the commencement of the epidemic. Woolwich,
however, had suffered comparatively little from smallpox, only four cases having occurred
there among the common lodging-house population, and there Appears to be no doubt that a smaller
proportion of persons of this class was vaccinated during 1901-2 in Woolwich than was the case
in many other parts of London. It may safely be assumed that, taking the common lodginghouse
population as a whole, nearly one-fourth were vaccinated during 1901-2. It should be
borne in mind, however, that the vaccination of common lodging-house inmates was much more
completely secured in some districts than in others ; in Marylebone and Southwark particularly
good results were obtained.
If 75 per cent. and 25 per cent. be taken as representing the proportions of those "revaccinated,
or having previously undergone attack by smallpox," and "once vaccinated,"
respectively at the outset, and if the persons vaccinated during the outbreak be supposed to
have been equally distributed between these two classes, it will follow that at the end of the
outbreak about 81 per cent. had been re-vaccinated prior to the end of the outbreak or attacked
by smallpox prior to the beginning of the outbreak, and that the remaining 19 per cent. had
been once vaccinated. During the outbreak about 2½ per cent. of the common lodginghouse
population contracted smallpox, this 2\ per cent. being drawn in the main from the
once vaccinated group, but including also a considerable proportion of those comprising the
very small number of unvaccinated. Thus finally it may be stated that about 83 per cent.
of the common lodging-house class had been re-vaccinated or attacked by smallpox at the
end of the outbreak, and about 17 per cent. remained in the class of once vaccinated only. This
last class, it will be observed, had diminished during the course of the outbreak from about 25
per cent. to the percentage (17 per cent.) just named.
The cases of smallpox among common lodging-house inmates in 1901-2 were, as has been
seen, almost entirely limited to the class of persons who had been vaccinated in infancy only—
there being scarcely any unvaccinated persons living in common lodging-houses. In claiming
its victims from the class in question, smallpox, as is its wont, affected more particularly those
upon whom the protection afforded by vaccination in infancy had been more remotely conferred.
The average man or woman in the 17 per cent. referred to above as remaining in the class of once
vaccinated only at the end of the outbreak was, it may be assumed, less likely to take smallpox,
under equal conditions of exposure, than the average individual in the original 25 per
cent. It cannot, however, be doubted that the 17 per cent., though they have escaped smallpox
in 1901-2, nevertheless consist in large part of more or less susceptible material. The
extent of limitation of smallpox to particular areas and particular houses in 1901-2 sufficiently
indicates that, more especially in the smaller houses and in outlying districts, many lodgers
must have altogether escaped being exposed to infection.
Methods adopted with a view to limiting the spread of infection.
(a) Quarantining inmates of infected houses.
This method was tried by the Council in only one instance, that of 8 and 10, Parker-street,
and the experience gained in this case was instructive.
In the absence of power to enforce quarantine, the maintenance of such a system is of
necessity dependent upon offering free lodging and free food to contacts. It was repeatedly
urged, on the occurrence of a case of smallpox in a common lodging-house, either that the house
should be closed or that all the inmates should be placed in quarantine for a period corresponding
to the incubation period of the disease. Closing the house was obviously most undesirable, the
object held in view being not to disperse the lodgers and so create fresh centres of infection, but
rather to keep them as far as possible together and under observation. To impose strict quarantine
upon all the inmates of the house would, had it been practicable, undoubtedly have been
the most efficient means of securing the desired end. An obvious initial objection to the proceeding
was its cost, the outlay necessary to induce lodgers to remain in the house quite prohibiting
its adoption on any considerable scale. In the instances in which this system was
* The inspector having in most instances made arrangements to be present at the time of attendance of the public vaccinator.