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29
Metropolitan borough.
Cases,
1902.
Case-rate per 1,000
living.
1892-1901.
1902.
Deaths,
1902.
Death-rate
per 1,000
living.
1902.
Rates* per 1,000
living, 1901-2.
Cases.
Deaths.
Paddington 113 0.1 0.8 20 0.14 0.4 0.07
Kensington 99 0.1 0.5 11 0.06 0.3 0.03
Hammersmith 100 0.1 0.9 13 0.11 0.6 0.12
Fulham 94 0.1 0.6 13 0.09 0.4 0.06
Chelsea 39 0.1 0.5 7 0.09 0.3 0.05
Westminster, City of 232 0.2 1.3 39 0.21 0.8 0.15
St. Marylebone 155 0.5 1.2 24 0.18 0.7 0.12
Hampstead 20 0.1 0.2 3 0.04 0.2 0.03
St. Pancras 360 0.2 1.5 81 0.34 1.2 0.26
Islington 302 0.1 0.9 54 0.16 0.5 0.09
Stoke Newington 51 0.1 1.0 8 0.15 0.7 0.11
Hackney 424 0.1 1.9 70 0.31 1.0 0.17
Holborn 219 0.6 3.7 46 0.77 3.5 0.65
Finsbury 211 0.2 2.1 36 0.35 1.4 0.21
London, City of 39 0.2 1.5 7 0.27 0.8 0.17
Shoreditch 442 0.1 3.7 76 0.63 1.8 0.34
Bethnal-green 515 0.3 3.9 64 0.48 2.0 0.25
Stepney 1,387 0.3 4.5 260 0.85 2.4 0.47
Poplar 630 0.3 3.7 93 0.54 2.0 0.30
Southwark 517 0.2 2.5 78 0.37 1.4 0.22
Bermondsey 224 0.2 1.7 31 0.23 1.2 0.17
Lambeth 362 0.1 1.2 60 0.19 0.7 0.11
Battersea 189 0.1 1.1 27 0.15 0.7 0.09
Wandsworth 131 0.0 0.5 25 0.10 0.3 0.06
Camberwell 356 0.1 1.3 63 0.24 0.7 0.13
Deptford 145 0.1 1.3 33 0.29 0.7 0.15
Greenwich 102 0.2 1.0 22 0.22 0.6 0.13
Lewisham 88 0.0 0.7 12 0.09 0.4 0.05
Woolwich 236 0.2 1.9 38 0.31 1.0 0.16
Port of London 14 — — — — — —
London 7,796 0.2 1.7 1,314 0.28 1.0 0.17
Administrative measures adopted for the limitation of the spread of smallpox.
(a) The diagnosis of smallpox.—When smallpox first appeared in London, 1901, there
were many medical practitioners who had not had experience of the appearances of the disease,
and quite early in the epidemic cases of smallpox were mistaken for chicken-pox. In October,
1901, in St. Pancras, and in the beginning of 1902, in certain other districts, the requirement of
notification was extended to chicken-pox, and on 28th January, 1902, the County Council, with
the consent of the Local Government Board, made an Order extending this requirement to the
whole of London. This requirement was continued in force until January, 1903, by subsequent
Orders made in April and October. The Council, moreover, in the early part of February,
1902, appointed medical men who had had experience of smallpox to consult with medical
practitioners who desired a further opinion on any suspected case of the disease. Under this
arrangement medical practitioners availed themselves of this opportunity in 1,153 cases in 1902.
Medical officers of health express different opinions as to the value of notification of
chicken-pox in bringing to their knowledge cases of smallpox which would otherwise have
remained unknown to them. Some are of opinion that it was not of practical value; on
the other hand, Dr. Bate, the medical officer of health of Bethnal-green, states that sixteen
persons who were reported to have chicken-pox were found on examination to be suffering from
smallpox, and he adds that "undoubtedly these persons would have remained at home distributing
infection had chicken-pox not been reportable." In Hackney twenty-two cases of smallpox were
mistaken for chicken-pox, and Dr. Warry, the medical officer of health, states that notification of
chicken-pox was a measure of great value. A smaller number of such cases is also reported by
some other medical officers of health as occurring in their districts. Thus, there were two cases
in Paddington, three cases in Woolwich, three cases in Finsbury, as well as two cases in Wandsworth,
which would not otherwise have become known. From returns furnished by medical
officers of health, relating to some 4,000 cases, it is recorded in more than 100 instances that,
infection was traceable to a previous case, erroneously regarded as chicken-pox. The use of
notification of chicken-pox cannot, however, be fully estimated by such occurrences, for not the
least of its value must undoubtedly have been the direction of public attention to the possibility
that cases of smallpox might be mistaken for chicken-pox, and to the need for more critical
examination of all persons suffering from eruptions presenting the appearance of chicken-pox.
Notwithstanding the efforts made to secure correct diagnosis, the reports of the Metropolitan
Asylums Board show that in 1901 13.3 per cent. of persons who were removed to the wharves, with
a view to transmission to the hospitals, were not, after removal, deemed to be suffering from
smallpox, and in 1902 in 8.8 per cent. of those thus removed the diagnosis was regarded as
erroneous.
(b) Removal to hospital.—With very few exceptions, the whole of the cases of smallpox
which became known to the medical officers of health were promptly removed to hospital by the
* These rates are calculated upon the number of cases notified during the two years after correction for errors in diagnosis. This
correction reduces the total notified cases by 6 per cent., a percentage which would probably have been much larger but for the fact
that notification was frequently delayed until after the diagnosis had been confirmed at the South Wharf.