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(6) Daily inspection of inmates of injected houses, with money payments in particular instances in which it was
deemed necessary to secure persons being kept under observation.
This system was found, provided considerable judgment was exercised in connection with
the offer of food and lodging, capable of being carried out in such a way as to secure the large
majority of the occupants of infected houses being kept under daily observation at quite a small
cost; in a considerable proportion of instances, moreover, such observation led to the early
isolation of cases developing the disease. At first it was thought that medical inspections of
inmates of infected houses in the early hours of the morning would be necessary, but as soon
as a considerable number of houses became involved it was seen that this plan, if adopted, would
involve retaining the services of medical men on a large scale.
In Southwark and in Stepney two medical men were specially engaged, with satisfactory
results, but for purposes of effectual and economical administration it was found that the better
plan was to rely in the first instance upon the services of the common lodging-house inspectors.
Three inspectors were told off to visit infected houses; the chief inspector also devoted practically
all his time to the work, and one of the Council's medical officers was summoned by telephone
or messenger in case of need. By reason of the intimate knowledge possessed by the inspectors
of the ways of occupants of common lodging-houses, and owing to the extent to which they were
able to learn from the lodgers themselves or by aid of deputies, night men, etc., when there was
any reason to suspect that a lodger was ill, they were able to effect far more than would have been
accomplished by medical inspection. Payment for beds was only exceptionally made, being
limited to those instances in which exposure to infection had been particularly intimate, while
if the lodger was destitute and unable to obtain work a small sum was given him for food.
Men in work were encouraged to pursue their daily employment, but were seen so far as was
practicable by the inspector each day. It was found that early morning visits, just when the
men had risen and were breakfasting and preparing for work, were best adapted for the purpose
of seeing lodgers. Deputies, etc., rendered assistance by detaining suspected cases until the
arrival of the inspector, in the event of there being at some other house a prior claim upon his
attendance. Some of the deputies threw themselves into this detective work with much zeal. As
soon as there was reasonable cause for suspicion lodgers were dispatched to one or other of the
points at which the Council's officer was likely to be found, and as a rule the deputy was able to
induce the sick lodger to go to bed and await the Council's officer s visit. One particularly
capable deputy was able to secure the notification and removal of a patient by keeping him for a
short time under lock and key, and the same deputy, in conjunction with one of the Council's inspectors,
had to forcibly hold down another lodger, covered with the smallpox eruption, until the
arrival of the ambulance. Concealed cases proved the main source of difficulty, concealment being
in some instances wilful, in others being associated with unwillingness to admit disability caused
by illness. The object steadily kept in view by the inspectors was that of bringing back to one
place of rendezvous day by day, for a period of at least a fortnight, all persons who had been
specially exposed to infection, so far as was reasonably practicable; it was by obtaining the confidence
of lodgers and deputies that the best results were achieved.
In the event of there being doubt as to whether or no a lodger was sickening with smallpox,
he was isolated, i.e., kept in a separate room in the lodging-house, and seen from time to
time by one of the Council's medical officers, the poor law medical officer, or some other medical
man. Keepers of common lodging-houses readily afforded all necessary facilities for carrying
out such isolation. In houses in which a group of cases had occurred a special room was by
permission of the keeper set apart for suspects, and thus in not a few instances lodgers were
removed as soon as it was possible to make a diagnosis of the nature of their disease.
The measure of success obtained by employment of the methods above detailed may
be gauged in the following manner. Returns prepared by the Metropolitan Asylums Board
give, in the majority of instances, the date of eruption and the date of removal. If to the cases
in which removal was effected on the day of appearance of the eruption the number one be affixed,
to those in which removal was effected on the second day the number two, and so on, and the
average of these numbers be taken, a figure is obtained which may be looked upon as a sort of
index of efficiency. This index in London cases (exclusive of common lodging-house cases) is
approximately 3. An average of 752 cases taken comparatively early, about the middle and
again towards the close of the epidemic, works out at 2.96. The corresponding average of 752
common lodging-house cases works out at 2.72, showing that despite the special difficulties encountered
in dealing with this section of the population, removal to hospital was secured on an
average some six hours earlier than was the case in the population as a whole. The average for
two large areas in which the system of supervision by the Council's inspectors had specially full
play works out at 2.40, representing a further improvement; removal of cases in the houses in these
areas being effected some eight hours earlier than in common lodging-houses generally, and some
fourteen hours earlier than in the population as a whole. Even in these areas it will be seen that
the period at which removal was effected was, on the average, only some 32-56 hours after the
appearance of the rash. The cases here in question of course include those constituting the original
source of infection in a house in which, it may be, the nature of the illness was for several days
unrecognised, as well as subsequent cases, some promptly isolated, some for a time concealed or
unrecognised. To materially reduce the index of efficiency below that obtained in the two
groups of lodging-houses nothing short of daily inspection of all the inmates of common lodginghouses
would have sufficed ; all that it was practicable for the Council's officers to attempt in the
way of inspection day by day was that of the occupants of particular houses, to which attention
had been specially directed by the occurrence and removal of a case of smallpox.
W. H. Hamer,
Assistant Medical Officer o f Health.