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Council. 227 notices were served to strip rooms after small-pox, 250 rooms were stripped by
landlords, the remainder being done by the Council. The notices served do not correspond to
the number of cases of small-pox, because rooms were done in many cases without notice, and
notices were not served when cases occurred in the workhouse or infirmaries, or in the shelters
of the Council. Repapering of the walls was not recommended to be done until 14 days had
elapsed from the removal of a case.
Notification of Chicken-pox.
The question of the advisability of making chicken-pox notifiable came up early this year,
since it is so frequently mistaken for small-pox. I did not advise this course because: (1) It was
likely to make some practitioners, upon whom the statutory obligation of diagnosis rests, not
quite so careful in endeavouring to differentiate between the two diseases. (2) To get the full
benefit all cases ought to be visited and examined by the Medical Officer of Health, and the
diagnoses confirmed or altered as the case may be. The practical objections to this are obvious.
And (3), it greatly increases the work of the already overburdened Public Health department.
The London County Council, however, found that there was a great lack of uniformity of
action among the Borough Councils, some requiring the disease to be notified, others not, and
determined to have uniformity. They therefore made chicken-pox notifiable in February for
three months, and at the end of that time made a further extension of six months. I think I
can show that the result, as far at least as Bermondsey is concerned, justifies the opinion
expressed by the Public Health Committee on my advice.
During this period, up to September 6th, there were in all 679 notifications of chicken-pox,
viz.: 427 for Bermondsey, 203 for Rotherhithe, and 49 for St. Olave's. In three cases only was
the diagnosis altered —one in Gareth Place, one in St. Helena Road, and one in Centre Block,
Vine Street Buildings.
In the first two cases the practitioner wrote asking me to see the cases, and merely notified
the cases as chicken-pox because it was notifiable. Had it not been so, they would have
simply written to ask it to be seen before notifying small-pox, or else have notified the latter
with a similar request, in the first place. The same remarks apply to the case in Vine Street
Buildings, with this addition, that there had been a case of genuine small-pox twelve days before
in the same tenement, of another member of the family. The expense of these notifications
£74 6s. The houses in which the cases occurred had all to be visited by an inspector,
and in many cases by myself. School certificates were sent off for every case.
This trouble and expense would be very slight if the amount of benefit derived in the check
of small-pox compensated for it, but I do not think it does. To visit all cases would be
impossible with the present staff, and would require the appointment of additional experts. I
certainly think that if a practitioner is in doubt as to whether a case is small-pox, and is really
anxious to act on the safe side, he can generally get a second opinion to at least share, if not
assume, the responsibility. Further, in Bermondsey, and, I presume, in other parts of London,
chicken-pox was not by any means the only disease mistaken for small-pox. In the early stages,
at least, small-pox was more commonly mistaken for influenza than any other disease, and many
cases were seen in surgeries of private practitioners, treated as influenza, and sent home to
develop small-pox a day or two later. The initial symptoms of the two diseases are exactly
similar, but it shows that when a case with symptoms of influenza comes for treatment it should
in times of small-pox prevalence be looked upon with suspicion and isolated for a day or two.
Other diseases which are commonly mistaken for small-pox are measles, scarlet fever, typhoid,
purpura, various forms of eczema, lichen, herpes, and other diseases too numerous to mention.
The diagnosis has, with few exceptions, been corrected at the wharf, and I doubt very much if
the appointment of experts by the London County Council has sensibly diminished these errors.
These will only be lessened by the increasing experience gained by the general practitioner and
by the exercise of the greatest possible care in acting for safety in doubtful cases.
I should like to have seen a few experts appointed who have had experience of small-pox under
the Asylums Board, or some similar institution, and whose services would be available in many
of the cases which presented difficulties even to those who have had a considerable amount of
experience of the disease already.
In the large majority of boroughs in London the Medical Officers of Health have acted as
small-pox experts, and although the statutory obligation to diagnose rests entirely with the
general practitioners, still, for the sake of the public health, the Medical Officers have given their
services freely when asked to do so.
On the first outbreak of small-pox in the Borough, I addressed a circular letter to all the
practitioners offering my services in assisting in the diagnosis of doubtful cases. When
chicken-pox was made notifiable by the London County Council, in addition to the notice
circulated by them, the Public Health Committee had a notice printed, drawing attention to the
fact that chicken-pox was notifiable. At the end of this notice, a similar offer of assistance in
diagnosis was made, and if the practitioner desired me to see any case of chicken-pox he was
asked to write his request on the notification form.
Practitioners availed themselves freely of my services during the whole period of the
epidemic.
In this connection I am unable to state accurately the number of cases seen by myself in consultation
as I was called upon at all hours, both on week days and Sundays. In this way I have
seen nearly a third of the actual cases, and a considerably larger number of suspected cases
which did not turn out to be small-pox. The number of doubtful cases seen in Bermondsey by
the experts of the London County Council during the period of which this report deals was ten.