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vaccination of the inmates on a large scale can be pointed to as at once bringing the outbreak to
an end; but the speedy detection and removal of infectious cases must have limited the exposure
of other inmates to infection and reduced the number of cases which otherwise would have occurred
among persons associating with the lodgers, whether within or outside the lodging-house. As a
rule, comparatively little success attended efforts to induce the inmates of common lodging-houses
to submit to vaccination. The Council exhibited a notice in all common lodging-houses advising
the inmates to seek this means of protection against smallpox, and the Council's officers exercised
such influence as they had over the lodgers, but the only inducement which was successful on a
large scale was the course adopted in a few instances by the sanitary authority, viz., the offer of
a small sum of money which would enable the lodger to live for a few days without work if
the effect of the vaccination was such as to prevent him from following his employment.
The behaviour of smallpox among the inmates of common lodging-houses was, as far as
practicable, studied during the epidemic, and Dr. Hamer has summarised the experience gained
in a report which is appended. (See appendix I.)
(g) General administrative measures.—The action of London sanitary authorities in dealing
with smallpox may be thus summarised. Notice of the occurrence of smallpox in any house was at
once given by the medical officer of health to the vaccination officer, and usually to the public
vaccinator, in order that the invaded house might be visited and the inmates who had been exposed
to smallpox might be vaccinated or re-vaccinated. Lists of the inmates were made, and the
names and addresses of persons who had been exposed to infection, and who were resident in other
districts were frequently communicated directly to the respective medical officers of health.
Particulars as to cases of smallpox and of the persons who were exposed to infection were, as
has been previously mentioned, sent to the County Council's medical officer, and through him
communicated daily to every medical officer of health in London. Persons who had been exposed
to infection were kept under observation until the expiration of the period of incubation so as to
secure the speedy removal to hospital of any of them who developed smallpox. House-to-house
inquiry in invaded areas for the purpose of securing the vaccination or re-vaccination of susceptible
persons was made. Particulars as to the course adopted in each district, especially in
connection with the steps taken to secure the vaccination and re-vaccination of susceptible persons,
may here be given—
Paddington.—Letters were addressed by the Public Health Department to all public
elementary schools other than those under the School Board and to all private schools recommending
vaccination, and asking for information as to unvaccinated children. In September, 1901, a
vaccination station was opened. In the same month the public vaccinator was authorised to have
the assistance of his deputy, and in January, 1902, a second assistant was appointed. Circulars
were delivered at the instance of the Board of Guardians at each house in the borough, recommending
vaccination and re-vaccination, and describing the arrangements which had been made. In
February, 1902, a house-to-house visitation was made by two of the district medical officers in the
"Clarendon-street area" to offer vaccination and re-vaccination to the inhabitants. Children in
elementary schools were not inspected. An assistant vaccination officer was appointed.
Kensington.—Notices were exhibited by the Board of Guardians giving the necessary
information and the names and addresses of the public vaccinators. Children in elementary
schools were inspected. No assistant vaccination officers were appointed. Under a system which
has been in operation in Kensington since 1887 medical practitioners notifying cases of smallpox
took the necessary steps for securing the patient's removal, receiving for this purpose a small fee
from the Borough Council.
Hammersmith.—Posters were exhibited by the Board of Guardians. No house-to-house
inspections were made. No assistant vaccination officers were appointed. No vaccination station
was opened. The arms of children in schools were not examined.
Chelsea.—The Board of Guardians appointed three assistant vaccinators for a period of
four months. To each of these additional vaccinators a district was assigned. The Board of
Guardians exhibited notices on the church and other public notice boards as to the arrangements
made for vaccination, and the Borough Council printed and circulated a leaflet recommending
vaccination and re-vaccination, which was left at every house in the borough. At the request of the
Public Health Committee the Board of Guardians authorised their public vaccinator and vaccination
officer to inspect the children in the elementary schools. No assistant vaccination officers were
appointed.
Fulham.—The Board of Guardians issued notices on the subject of vaccination. Inquiries
were made by the medical officer of health and the vaccination officer in invaded areas, and children
in elementary schools were inspected by the public vaccinator on the application of the Board
of Guardians. No assistant vaccination officers were appointed.
Westminster.—The City Council issued notices to employers, hotels and clubs throughout
the City, recommending re-vaccination. The Strand and Westminster Guardians took early
steps in the matter of vaccination. The St. George's Guardians eventually fell into line with the
other two Boards. The St. Clement Danes Hall was opened by the Strand Guardians as a vaccination
station from the 29th October to the 23rd December, 1901, and from the 24th January
to the 11th April, 1902, and three deputy vaccinators were appointed. Children in schools were
inspected in each Union.
St. Marylebone.—Posters were exhibited and communications sent to all employers and to
all schools. Three assistant public vaccinators were appointed, two public vaccination stations
were opened. Children in schools were inspected, a house-to-house visitation was made except in
"well-to-do" streets, and children inspected where possible.
Hampstead.—Posters were exhibited and a house-to-house inquiry made. Two additional
vaccinators were appointed and two stations opened. No additional vaccination officers were
appointed.