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London County Council.
OCCUPATION OF PERSONS ATTACKED BY SMALLPOX.
Presented to the Public Health Committee, 17th December, 1903.
Shirley F. Murphy,
Medical Officer of Health.
Dr. Hamer's Report.
Analysis of the returns made by medical officers of health furnishes information which
throws light upon some of the ways in which smallpox was spread during the outbreak 1901-2.
The returns in the majority of instances indicate the occupation and the place of employment
of the person attacked. A study of the particulars given clearly indicates that the sufferers
were largely drawn from certain sections of the population, and it is difficult, therefore, to
formulate precise ideas as to the way in which the occupations of the sufferers might be expected
to group themselves. Clearly the census returns of occupations and the data furnished by Mr.
Charles Booth in his "Life and Labour of the People in London" cannot be appealed to for comparative
purposes, as the figures in both these instances relate to the population as a whole.
The sufferers from smallpox, concerning whom particulars are given in the returns now in question,
contain many labourers, housewives, schoolchildren, carpenters, painters, tailors, dressmakers,
plumbers, plasterers, and so on. To attempt to estimate whether headings such as these
appear, among the 4,000 entries,* with greater or less frequency than might have been anticipated,
is not likely to be profitable ; the terms are, of course, not used with any common understanding
as to definition, and it is difficult, to take a concrete instance, to know how to deal
with expressions such as "milliner," "machinist," " mantle maker," "blouse maker," and to
decide whether they should or should not be held to fall appropriately under the generic term
"dressmaker"; again, "labourer" is a very indefinite expression; "charwoman," "cleaner,"
"laundress," and "domestic duties" may be more or less interchangeable, and so on. All that can be
done in these circumstances is to make some comment upon the particular occupations, which stand
out so strikingly among the headings returned, as to make it appear that special circumstances
have determined the incidence in question.
In doing this, the order of the 24 headings adopted in the census return may be conveniently
followed. Tender the professional class the Registrar-General includes three headings.
(1) General or local government, represented, among smallpox sufferers, by three police constables,
a rate collector, an assistant relieving officer, a clerk to a public vaccinator,
two sanitary inspectors, and no fewer than 38 disinfectors (i.e., persons engaged in work in
connection with the disinfection of articles or rooms). (2) 1"he defence of the country is very
poorly represented by a soldier or two. (3) Professional occupations. Here, clergymen, priests,
ministers, are conspicuous by their absence, though among those attacked were, it may be noted,
a City missionary, a pew opener, and a lady visitor. The legal profession supplies a solicitor and
two law writers; the medical, a doctor; while it may be noted that two doctors' servants, the son
of a caretaker of a surgery, a chemist's assistant, a chemist's errand boy, a nurse, a housemaid
at a general hospital, a cleaner at a fever hospital, and an attendant at an ambulance station
are also returned among the 4,000 sufferers. To this professional class there remain to be added
two schoolmasters, one or two actresses, a newspaper reporter, ten newsboys, the "daughter of a
dramatic author," and an "artist's model."
The domestic class (4) contains a few domestic servants, eight waiters, five waitresses,
together with no fewer than 29 women and 58 men engaged in service in connection with publichouses,
most of the 29 women being barmaids, and the majority of the 58 men barmen and potmen.
That 87 persons working in public-houses should be attacked is at first sight very surprising,
and, taken in conjunction with the fact that in 18 instances (over and above the 87
referred to) infection is stated to have been contracted in a public-house, it might be held that
question should be raised as to some special reason for the association in so marked a manner of
the public-house with smallpox infection. In certain parts of London, however, there is one
public-house to every 25 dwelling-houses, and the number of persons occupied in or in connection
with public-houses must form a considerable percentage of the population in such localities.
To determine what the percentage of the total population belonging to the particular class
likely, cceteris paribus, to be attacked actually is, it is necessary to ascertain how many persons
should be allocated to a public - house. Mr. Shapley, one of the Council's inspectors,
has consulted a lodging-house deputy who is now a teetotaller, but who has intimate knowledge
concerning the personnel of nineteen public-houses and beer-houses in his neighbourhood, and it
transpires that the average number of persons to be allotted to a public-house is 52. Taking the
number to be assigned to each ordinary dwelling-house at ten, this would make it probable a priori,
other things being: equal, that about one in every fifty persons attacked would be associated with
public-houses. This result is in close correspondence with the actual facts. Having regard,
however, to the fact that the persons associated with public-houses belong in many instances
(publicans, publicans' wives, etc.) to a class sociallv superior to that which has generally been
attacked in London as a whole, and to the further fact that exposure to infection in the publichouse
is limited as to time and so on, it must be admitted that it is not a little remarkable the
number of sufferers associated with public-houses should be so large.
Under the Registrar-General's heading (5) "Commercial occupations" there are but few
entries to be made ; a commercial traveller should certainly be included, and presumablv also
four insurance agents, and four bookmakers' clerks. The insurance agent and the bookmaker's
clerk, it will be seen, suffer with the rate collector already referred to, and in this connection it
* There are upwards of 5,000 returns, but only in about 80 per cent. of these are there entries under the headings here in question.
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