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of the body and is practically always fatal. In two or three instances the cases
were so malignant that the patients died before the characteristic eruption showed
itself. In one case death occurred with great rapidity. A young man, aged 18, an
inmate of the Shoreditch Infirmary was convalescent from a febrile complaint of a
doubtful nature, probably typhoid fever, Ho was noticed to be not so well one day
and died somewhat suddenly the noxt, within 24 hours from the onset of symptoms.
There were observable two or throo faint bluish marks over his shins and one or two
over the lower part of his abdomen. A post mortem examination was made which
left no doubt as to tho cause of death, There was scarcely an organ in his body in
which hæmorrhage or bleeding had not occurred. It is hardly necessary to state that
this malignnnt rapidly fatal form of small-pox is very liable to be mistaken for something
else and when such a mistake is made, the consequences may be very grave, for
this form of the disease is very infectious.
With respect to the measures adopted in the Borough to prevent the spread of
infection the following summarises the steps taken: As soon as possible after cases
were reported they were removed to hospital. The necessary arrangements were
made for securing the removal of cases reported after the usual office hours and on
Sundays when tho offices were closed. To cope with the increased work the number
of men employed in disinfecting was increased from three to six. Disinfections were
carried out as soon after the removals of cases as possible, in accordance with the
instructions of tho medical officer of health and under the supervision of the sanitary
inspectors. All disinfections, with a few exceptions in special cases, were effected the
same days cases wore removed, Sundays included.
Infected rooms were stripped of all textile articles and fumigated with sulphur
dioxide evolved from burning sulphur in iron pans. The time allowed for fumigation
varied from about six hours to forty eight-hours according to circumstances. After
fumigation the rooms in which cases had been were thoroughly ventilated and the
floors and woodwork generally, including that of all landings and stairs, were washed
down by the occupiers of the rooms with soap and water mixed with carbolic acid.
In cases in which it appeared necessary the walls were stripped of paper by the officers
of the Borough Council and'the paper so removed was burnt in the fireplace belonging
to the room. Walls were allowed to stand bare of paper until it was deemed safe for
workmen to enter for the purpose of repapering, that is until the period of incubation
of the disease was safely passed. In some cases walls were rubbed down with bread
crumbs and carbolic powder which were swept up and burnt. In cases where the
wall papers were clean and in good condition, under ordinary circumstances fumigation
with free ventilation were considered sufficient.
Textile articles, including bedding, carpets, curtains and the like, were removed
from the infected rooms with the usual precautions and disinfected by steam under
pressure at the disinfecting station belonging to the Borough. The disinfecting
apparatus used was manufactured by Messrs Goddard Massey and Warner (Washington
Lyon's Patent). The clothing of the inhabitants of the infected dwellings and
of any other persons who were found to have been exposed to infection was also