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Metropolitan Asylums Board. In a few instances the nature of the malady was not recognised
until the sufferer was found to be dying from a malignant type of the disease. In certain other
cases the disease was not recognised until after recovery. In no single instance was failure reported
to remove to hospital cases of the disease for which application was made, and testimony to the
promptitude with which removals were effected is found in many of the reports of medical officers
of health.
(c) The supervision of persons exposed to infection.—The system of keeping under
observation persons who had been exposed to infection was largely adopted during the
epidemic. This, indeed, was a course followed in every district, and early in 1902 the Council's
Public Health Department was utilised for immediate daily distribution to every
medical officer of health in London of particulars as to cases of smallpox occurring, and also of
the addresses of persons who had been exposed to infection, this information being transmitted
by medical officers of health for this purpose. In this way, medical officers of health obtained
information of the addresses of persons residing in their districts who had been exposed to infection
in other districts, and such "contacts" were able to be visited, offered vaccination, and
removed to hospital in an early stage of the disease if they subsequently sickened with smallpox.
It was a frequent practice, especially in the early part of the epidemic, to endeavour to
limit the extension of disease by informing employers whenever any of their staff were found to
have been living in a house in which a case of smallpox occurred. The result was, in many cases,
that the employee was suspended from work, and where no allowance was made for his maintenance
or that of his family by his employer, or by the sanitary authority, hardship was often
suffered. Dr. Warry gives his experience in Hackney of this procedure. "The result, in
the majority of cases, was that many persons were reduced to the brink of starvation, for a large
number, although in great want, would not apply for parish relief ; and as a matter of fact, the
Guardian officials did not like persons coming from infected houses and applying for relief,
neither did they like visiting the unfortunate contacts in their houses." Nor does the result of
such action always appear to have been of sufficient value to compensate for the disturbance of wage
earning. Dr. Harris, medical officer of health of Islington, found that "these employees were
thrown on their own resources to fill in their time, and although they might stay at home for a
few days, they would then generally go into the streets, loiter at the hall doors, or find their way to
the nearest public-house.''
Question, therefore, arose in a number of districts whether steps should be taken to prevent
the extension of disease by inducing the inmates of infected houses to remain within doors,
a course which involved the abandonment of work and wage earning, and the maintenance of the
household at the cost of the rates. In February, 1902, the Local Government Board addressed a
circular letter to London sanitary authorities on the question of the quarantining of persons
living in dwellings invaded by smallpox. The letter stated that the Board "are advised
that under ordinary circumstances the quarantining at their homes of inmates of such dwellings
is not necessary in districts in which sanitary matters are properly administered and vaccination
and re-vaccination are properly carried out. If, on a dwelling becoming invaded by smallpox,
the actual patients are at once removed to hospital, the dwelling, and all articles in it that have
been exposed to infection, including the clothes worn by the other inmates, are properly disinfected,
and the other inmates of the house are immediately vaccinated or re-vaccinated (as the
case may be), there is no material advantage to be gained by keeping these other inmates at home.
They are not likely to infect other people unless they themselves develop smallpox ; and all that
is required is to keep such persons under medical observation for a fortnight, and particularly to
examine them carefully day by day towards the end of the second week from their exposure to
infection, in order to ascertain whether any of them are developing smallpox. If none of them
do so by the beginning of the third week from exposure, the re-vaccination (or vaccination) to
which they were submitted on the occurrence of the first case in the invaded house should secure
them from attack by the disease. The Board considers that in ordinary circumstances the course
of action indicated above is the correct one. Occasions, however, may arise in which additional
precautions may be necessary, as, for example, when laundries are in question, or where the
business or habits of the members of the invaded house are such as to make it difficult for
medical observation of them to be maintained. In exceptional cases of this kind, in which the
Council are advised by their medical officer of health that in the special circumstances it is
essential that the inmates should remain in their own houses, the Board would be prepared
to sanction a reasonable expenditure in securing such a result.''
The impracticability of the wholesale quarantining of all persons exposed to infection when
smallpox is widely distributed is, of course, obvious. The actual number of such persons during
the recent epidemic cannot be shown, but some idea of the magnitude of this number can be formed
by reference to the annual reports of a few of the medical officers of health.
Thus in Westminster, where there were 301 cases of smallpox, there were 2,677 persons
living in houses in which cases of smallpox occurred, and there were 3,108 additional
"contacts" who had otherwise been exposed to smallpox bv visiting persons suffering from the
disease, or working with such persons, or in other ways. In Woolwich, in which 245 cases of
smallpox occurred, there were 1,073 "contacts." In Lambeth, where 404 cases of smallpox
occurred, there were 4,182 "contacts" exposed to infection in the district, and 739 "contacts"
exposed to infection elsewhere. In Wandsworth, in which 143 cases of smallpox occurred,
there were 880 "contacts." In these districts there were, therefore, 1,093 cases of smallpox and
13,259 "contacts."
Only in Poplar was money expended on a large scale in providing for "contacts" in their
own homes. Thus between the 4th December, 1901, and the 12th September, 1902, in which period
some 660 cases of smallpox occurred, £1,089 was expended on the supply of food to persons whom