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inmates of the workhouse from small-pox numbered six, of which one occurred in
December, 1901. The case-mortality during the outbreak was therefore 18.7 per cent.
The occurrence of so many cases in the Holborn Workhouse was a real danger to
the inmates and for a time the aspect was very threatening. The energetic action of
the officers of the institution, however, saved the situation and a more serious outbreak
was averted. The measures for preventing the spread of the disease adopted by
Dr. Evans, the medical officer to the Workhouse, included the prompt isolation of
any eases of illness raising the least suspicion of small-pox, suitable isolation wards
being provided for this purpose; the removal to hospital of all cases of small-pox as
soon as the eruption was sufficiently pronounced for the diagnosis to be made; the
destruction of all infected bedding in a destructor on the premises; the disinfection of
the wards where the cases had been; and, the vaccination and re-vaccination of all
inmates who were willing to submit to the operation. Of some 1400 persons in the
institution 1155 were vaccinated or re-vaccinated in consequence of the outbreak. It
may be remarked that none of the inmates who had been re-vaccinated before exposure
to infection took the disease. The rapid cessation of the outbreak in February
was without doubt mainly due to the prompt isolation of the cases and the activity
displayed in respect to vaccination.
A few remarks bearing upon the severity of the attacks so far as they were observed
in Shoreditch will perhaps not be out of place. As a rule the attacks were
much less severe in the vaccinated than in the unvaccinated. Several extremely mild
cases were noticed in which the eruption was limited to less than a dozen spots. All
these cases were amongst vaccinated persons. The most striking instance of scanty
eruption which came under observation was that of a lad who had been vaccinated in
infancy and re-vaccinated about three days after exposure to infection, his father
having been removed with small-pox. The eruption at the time of the lad's removal
was limited to one typical spot on the back of one of his fingers and two abortive, one
on one of his legs and the other on his right side. The following case is also worthy
of note : A woman who had been exposed to infection was, at the end of the time
corresponding to the period of incubation, taken ill with symptoms which usually
precede the appearance of the eruption of small-pox. She was at the time at the
temporary shelter whilst her dwelling was undergoing disinfection for the second
time. A rash developed on both arms and on her legs in the neighbourhood of her
ankles, which was without doubt the characteristic measly prodromal eruption of
small pox. She was then feeling better. She was kept under observation for four or
five days at the shelter and examined two or three times for the eruption of small-pox,
the measly rash having disappeared, but no trace of a spot could be discovered. She
was then feeling quite well and was allowed to return home after a bath, having had
her clothing disinfected. This case was probably one of small-pox without eruption.
Cases of a severe type were unfortunately numerous and, as can be seen by reference
to Table VIII. some eighteen or nineteen, all of which were fatal, were of the extremely
severe form known as hæmorrhagic or "black" small-pox. This terrible variety
of the disease is characterised by bleedings under the skin and in the various organs