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not a matter for surprise, for Small-pox is now, fortunately,
so rare a disease in this country that many medical men have
practised for years without having ever seen a single case.
Medical diagnosis is an art involving the trained use of the
senses, and, like all arts, can only be acquired by practice.
In order to recognise Small-pox it is necessary to have seen
Small-pox, for, obviously, a man cannot be expected to
recognise something he has never seen before. As certain
diseases become rarer owing to the advance of sanitary science,
so does the inability of the medical profession to recognise such
diseases increase, and the freedom of a country from any
particular disease may be gauged by the degree to which the
medical men are unfamiliar with its clinical features, and are,
therefore unable to diagnose it. A prolonged period of
Small-pox prevalence would undoubtedly vastly increase the
diagnostic capacity of the profession in relation to the disease,
and mistakes such as those set out in this report would not
occur ; but this can hardly be regarded as a " consummation
devoutly to be wished." It is to be hoped that opportunities
for acquiring clinical experience in Small-pox will become
considerably less in the future than has been the case in the
past.
It is, of course, open to a practitioner to seek a second
opinion, and, although it is, strictly speaking, no part of
the duty of a Medical Officer of Health to act as consultant
diagnostician to the practitioners of his district, in most
districts, and certainly in Battersea, the local medical men are
well aware that the Medical Officer of Health, who has
naturally had unusual opportunities for making himself familiar
with Small-pox, is always willing to render what assistance he
can. Since Small-pox appeared in Battersea in October, 1901,
I have been called in to see a large number of cases, and have
been glad to have had an opportunity afforded me of seeing
possible cases of Small-pox at the earliest possible moment.
Some practitioners, however, are disinclined to seek assistance,
particularly where the case seems fairly clear, and prefer to
take the responsibility of making a decision on their own
shoulders. What is needed is an extension of the law relating