There were occasional outbreaks over the years in which patients suffered the tell-tale symptoms of the infection including backache, digestive disorders, fever, vomiting and the appearance of numerous pocks or pustules, skin eruptions that left pitted scars if the patient survived. The cause of the disease has never been determined exactly but low standards of nutrition and a general uncleanliness were regarded as a cause of infection.

Family doctors were often unable to diagnose the signs and symptoms correctly and commonly confused them with chicken pox, a situation that occurred during the Bourne smallpox outbreak in the late 19th century. At this time, there was a great deal of ignorance about the illness and in particular, whether vaccination was a suitable precaution against infection with the result that few people had received one and so any outbreak soon spread.

The Bourne epidemic began in February 1893 when the Midland and Great Northern Railway Company were building a track through the district to link it with what is now the main east coast line at Little Bytham. Irish navvies had been brought in to carry out the work and the disease broke out initially among those employed in the Castle Bytham and Thurlby areas and as some of them were living at a common lodging house in South Street, the infection soon spread to the town, notably to several inmates of the workhouse in St Peter's Road. 

The workhouse medical officer was undecided whether those who had been taken ill had smallpox or chicken pox and in a state of near panic, the Board of Guardians who ran the institution telegraphed the Local Government Board in London to "urgently send an inspector to verify the diagnoses".

The board refused the request saying: "If the medical officer to the Board of Guardians and the town's Medical Officer of Health [they were in fact, the same person] are unequal to verify these cases, it simply means that they are unfit for their posts. This board has no army of inspectors from which they can comply with requests like this."

There was panic in the town as parents tried to take precautions to protect their children. Some kept them at home at the slightest sign of illness and those from the workhouse were ordered not to attend lessons at the council school in Abbey Road.

By this time, the number of cases was increasing but medical facilities to treat them were totally inadequate. The Bourne Fever Hospital had been set up in 1885 after the Rural Sanitary Authority purchased and converted four empty cottages in Manor Lane for the purpose but this provided only basic accommodation with ten beds in two wards for dealing with patients who needed to be isolated because they were suffering from an infectious disease.

A makeshift hospital had also been opened by the railway company at Castle Bytham to help cope with the outbreak but this was little more than a primitive building that became known locally as the Small Pox Hut and is recorded on maps of the period as the Fever Hospital, being used for those navvies who had contracted the disease. But there was no room for further cases and all that could be done locally was to isolate and disinfect the patients. 

On February 25th, the medical officer wrote to the Board of Guardians saying: "The cases of sickness in the Bourne workhouse are chicken pox and not smallpox and I cannot account for the disease except through tramps coming in and as far as I can ascertain there is not, up to the present time, a single case of smallpox or chicken pox in Bourne town. As regards the Bourne Fever Hospital, I have repeatedly pointed out its defects, to wit: water supply, none; drainage, inefficient; ventilation, imperfect; arrangements for lighting, cooking and bathing, inefficient; no apparatus for disinfection of clothes; no store room; no ambulance; no water closet; no mortuary. In my opinion, a temporary hospital should immediately be constructed. Otherwise, if infectious diseases are promiscuously congregated together, the death rate will be considerably increased."

It was left to a country doctor, Dr John Galletly (senior), who was also the public vaccinator for the Rippingale district, to raise the alarm because he warned on March 9th: "Smallpox is breaking out in the district" and as the number of victims increased, they were sent to the fever hospital in Manor Lane. By now, they needed full time care and so the Nurses' Institute at Hull was contacted and one of their staff, Nurse Maud Beesley, volunteered to come to Bourne and look after the smallpox sufferers.

At last, on April 27th, the Local Government Board agreed to send an inspector and in his subsequent report, he stated that the workhouse medical officer had told him that there had been two cases of smallpox at the workhouse but that he had persistently described them as chicken pox and purposely concealed their true nature, presumably to avoid panic or because he could not distinguish between the two.

There also appears to have been an official reluctance to say how many people had been affected by the disease to abate public alarm but a newspaper report in June 1893 gave some figures relating to the outbreak. By this time, the epidemic had subsided and only four cases remained under treatment, two at Bourne and two at Castle Bytham and three of these were convalescent. The report added: "Since the outbreak, the number of cases has been 33, three of which proved fatal. The introduction of the disease is attributed to navvies working on the new line."

With the outbreak under control, Nurse Beesley returned to her normal duties in Hull but the town acknowledged "her cheerful and invaluable service in nursing some of the smallpox sufferers single-handed" and the Medical Officer of Health, Dr James Watson Burdwood, presented her with a travelling bag together with a purse of money and an illuminated address.

The fever hospital continued in use until Bourne Hospital with its own isolation wards opened in 1915 when it was closed down and the two cottages were sold.