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being thought that such appointments, if required, should be made
by the Metropolitan City and Borough Councils concerned. As
regards Lambeth, objection was taken on behalf of the Borough
Council by your Medical Officer of Health in a letter dated
February 20th, 1902, and previously at a personal interview with
the London County Council's Medical Officer, with the result
that no experts were appointed in Lambeth. The Borough
Council protested formally on March 6ih, 1902. Experts living in
neighbouring Boroughs were, in a very few instances (less than
a dozen), called in in connection with doubtful cases occurring in
Lambeth Borough, and in three instances the diagnoses made by
such experts were found to be wrong—in one instance (a case of
Smallpox diagnosed by the expert as Chickenpox) 5 cases arising
therefrom, and in the others, the patients (suffering from Chickenpox,
but diagnosed by the experts as suffering from Smallpox) being
removed to the Smallpox Hospital (but fortunately sent back
at once). It is clear that such appointments of experts should be
made by the Borough Councils concerned, so that the greatest
care might be exercised in order to secure the services of only
competent men (if their services are required at all) to act under,
and be responsible to, the Medical Officers of Health.The
Society of Metropolitan Medical Officers of Health protested
officially against the appointments of these experts by the London
County Council.
In Lambeth, the Medical Officer of Health acted as expert and
consultant for the Borough, and this arrangement was found to
work well, though much extra work devolved in consequence upon
such officer.
Before leaving the subject of notification, it is only fair to state
that, speaking generally, the promptness with which the cases of
Smallpox (and all doubtful cases) have been notified throughout
the Borough calls for special mention, and that in this connection
the medical men practising in Lambeth are to be congratulated.
There can be little doubt that the circular letter, which was sent
out early in the epidemic, helped materially in securing the prompt
notification of all cases.
2. Isolation.
Every case was at once removed to Hospital*—a most efficient,
and the only efficient, way of isolating Smallpox patients. Isolation
at home is practically impossible, and everything depends
on the cases being isolated in Hospital as soon as notified. This
*Two patients (malignant Smallpox), died before the ambulance arrived
so that they could not be removed to Hospital. Their bodies were at once
removed to the Mortuary for infectious cases, at Wanless Road, to await
burial, at a cost of £1 14s. 6d. Strict precautions were taken as to disinfection,
etc.