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(d) careful investigation of each case; (e) vaccination and revaccination;
(f) supervision of contact persons; (g) inspection of premises,
including periodical inspection of Common Lodging Houses.
It may be desirable to emphasise one or two points respecting
these methods of prevention.
(1.) We have made the greatest efforts to ensure immediate
isolation. The importance of early removal of all cases of small-pox
in a central borough like Finsbury (with 172 persons to the acre and
10 9 to the house) can scarcely be exaggerated. It is, of course, to
the advantage of the patient; it is still more to the advantage of the
community. In this connection it should be remembered that
small-pox, when the rash is first beginning, is much less infectious
than at later stages. We are greatly indepted in Finsbury to the
rapid removal system of the Metropolitan Asylums Board which
has operated with complete success in this Borough, except after
midnight, when on one or two occasions we had great difficulty in
getting cases away.
(2.) Our system of disinfection was also arranged with the object
of thoroughness and promptitude. Experience shows that the chief
point to be borne in mind in this connection is that the disinfection
shall be prompt. Promptitude in application is probably of more
importance in small-pox than extreme measures. In only one or
two cases was it found necessary to burn the clothes and
bedding of the patient. In all cases the rooms have been promptly
sealed up and fumigated with Formic Aldehyde (in a few cases with
Sulphur), and the next day sprayed throughout with Chloride of
Lime (1½ ounces to the gallon). Where necessary the walls have
been stripped and cleansed. The clothing and bedding, in all cases,
has been thoroughly disinfected by steam, and where destroyed
compensation has been paid.
(3.) Investigation of each Case. — In my judgment, emphasis
should be laid upon this point. The careful and systematic
investigation of each case of small-pox is the only way in which
we can expect to check the spread of the disease. That is
to say by such enquiry we obtain the data upon which to proceed.