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20
SMALL-POX.
patient in the same ward removed from some other district (unknown) who developed small-pox
after admission. F. G. was infected by this patient.
(e) Case reported from Acton, 19th November.
C. G., f. 28; a nurse, was in service in Paddington for three weeks prior to 13th November.
She went to Acton 14th November, the rash came out on the 15th, and she was removed to hospital
on 17th. Inquiries made in Paddington failed to trace the origin of the case, and no other case is
known to have been connected with it.
The action taken by the Department to check the spread of the disease included prompt
removal to hospital of each case, followed by equally prompt disinfection, notification of each case
to the Guardians, as required by the Local Government Board, combined with advice and persuasion
to secure the vaccination or re-vaccination of all those who had been in contact with the case, and
observation of all such " contacts" during the fortnight following the removal of the case to
hospital. Of the 22 cases notified, only 4 were not removed to hospital, 3 of the cases being allowed to
remain at home as they were recognized by the Medical Officer of Health to be chicken-pox and not
small-pox. The fourth case, the first of the cases recorded above, was not removed, as the diagnosis
of small-pox was not made until she had passed through all the stages of the disease, the attack
being an exceedingly trifling one. For disinfection the formaldehyde spray has been used, in
preference to fumigation with sulphur. The latter method has long been under suspicion, although
actual failure of efficiency has never been proved. The spray method has the advantages of applying
the disinfectant, formic aldehyde, in a liquid form, regarded by all observers as the most efficient
method of application, and of requiring a very brief time for its application. A room disinfected
during the day can be used the same night. In addition, all articles which were believed to have
been exposed to infection were removed and treated with current steam, and afterwards cleansed.
The duty of providing for vaccination rests with the Guardians, and a record of the steps taken will
doubtless be included in the Annual Report of the Board for the year. The Officers of the
Department used their' best endeavours to persuade all those known to have been exposed to
infection to take immediate steps to renew the protection afforded by efficient vaccination. In
September the following circular letter was sent out to the Teachers of all the (Voluntary)
Elementary Schools in the Borough, and to all the private schools known to the Department:—
SMALL-POX.
Having regard to the continued prevalence of Small-pox in the Metropolis, I have
been instructed by the Public Health Committee of this Borough to write to you and to urge
you to take steps to have the Staff of your School adequately protected by vaccination. All
who have not been re-vaccinated within the last five (5) years should be done now. The
parents of children known to you to be unvaccinated should be urged to have their children
vaccinated without delay. The origin of any communications respecting such children,
if addressed to me, will be treated as confidential, but the names and addresses will be communicated
to the proper officials to enable steps to be taken to secure vaccination being done.
Small-pox in the vaccinated is very often so trivial a complaint to the patient that no
notice is taken of the attack. Such a mild attack is, however, able to give rise to the disease
in its most virulent form in an unprotected person. Backache, headache, sickness, some
fever and " spots" may be taken as symptoms of importance just now. Those suffering from
such symptoms should be sent home and be excluded from school until he or she has been
seen by a medical practitioner. All such exclusions should be at once reported to the
Medical Officer of Health of the district in which the excluded person resides, as well as to
me. Modified small-pox does not, however, occur in young children. This form of the
disease is to be looked for among the vaccinated children in the senior departments and
among the Staff. Simple or unmodified small-pox, i.e., in persons not protected by vaccination,
is almost invariably so severe in its onset as to preclude any attempt on the part of
those affected to attend school or other occupation.
If I can advise you on any matter arising out of this letter, I shall be pleased to see
you here any day between 10 and 11.30 a.m., or at other times by appointment.