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without delay. Each case was reported to the Vaccination Officer, and to the Public Vaccinator
direct. Re-vaccination of "contacts" and other inmates of infected houses was carried out
to the fullest practicable extent, the offered means of protection having been very generally
accepted.
Comparatively few medical men of the present generation have had opportunities for
becoming practically acquainted with small-pox, and to this circumstance, leading to nonrecognition,
the spread of the malady is frequently due. A suggestion was made by the Medical
Officer of Health of the Borough of St. Marylebone, that the Asylums Hoard should obtain, and
put on sale, naturally coloured lithographic drawings illustrative of the small-pox rash. "Were
such drawings distributed to medical practitioners, there would be less liability to the spread
of small-pox through mild and unrecognised cases. Sometimes the illness is so slight, the rash
so sparse and inconspicuous, that medical men who have not seen small-pox, may be excused
for not realizing that so apparently trifling an ailment can really be the disease which,
in its worst aspects, is about the most loathsome that can befall man. These mild cases are
often mistaken for chicken-pox (just as severe cases of chicken-pox are mistaken for small-pox),
and from the public health point of view are the most to be dreaded as leading to the spread of
infection. The sufferers are sometimes not ill enough to need to lie up, or even to remain in
the house, after a 'day or two ; they are, nevertheless, able to give the disease in its worst forms
to susceptible persons, i.e., those unprotected by vaccination.
Diagnosis of Small-pox.—In connection with the diagnosis of small-pox I thought it well
io forward to medical practitioners within the borough a letter as follows: —
" Small-pox being now so prevalent, I beg to invite your attention to the subjoined extract from
the last annual report of the Medical Superintendent of the Hospital Ships—
" ' Small-pox is a disease which in practice seems to present more difficulties in its detection
than do most others ; it is also the disease in which mistakes are of most
moment. It is unfortunate that medical men, as a rule, do not conceive it
to be their duty to notify all cases where a diagnosis of small-pox appears to be not
only possibly but probably the correct one, and to allow the responsibility of deciding
as to the disposal of such cases to rest with the Managers.
" The course recommended is the removal of any doubtful case to the Asylums Board's Shelter
at Rotherhithe. If the disease proves to be small-pox the patient will be removed to hospital
forthwith ; if clearly not small-pox, he will be revaccinated and sent home again. Should
the diagnosis be in doubt, he will be detained in the isolation ward so long as may be
necessary.
" The patient would be removed to the Shelter immediately on your application, by telegram
addressed ' Asylums Board, London,' and stating name, age, sex, disease, and address,
together with your own name and address. Applications may be made by telephone, the
Board's numbers being 1601 and 1602 Holborn.
"The Board's offices on the Embankment are open from 9 a.m. to 8 p.m. on all days of the
year. Between 8 p.m. and 9 a.m. the application must be made at the Western Ambulance
Station, adjoining the Western Hospital, Seagrave-road, Fulham.
" I may remind you that it is necessary to leave at the patient's home a certificate to the effect
that he or she has small-pox. Without such certificate the Ambulance Nurse is not permitted
to remove the case. The Council will defray the cost of the telegram, and pay a fee
of half-a-crown for the certificate.
" In any suspicious case, I think you will agree with me that it would be better to take advantage
of the opportunity thus afforded for diagnosis and isolation than, by keeping the patient
at home till the diagnosis is cleared up, risk spread of the disease."
This communication had good effect for nearly all of our cases were removed to hospital
forthwith by the doctors themselves.
Action of the Local Government Board.-— In a circular letter, dated 25th September, the
Local Government Board informed the Borough Council that they attached very great importance
to the most energetic measures being taken with the view of preventing the spread
of infection, and requested the Council to instruct their Medical Officer of Health to visit the
houses where the disease broke out, and to take such measures as might be necessary to secure
the isolation of the sick, the vaccination of any persons who had been exposed to infection, and
the disinfection of the premises. The Board deemed it advisable that the Council should, in each
case, be informed of the measures taken by the Medical Officer of Health, and requested to be
furnished with copies of that officer's reports on the subject. The Board, moreover, circulated
a memorandum by their own Medical Officer, explaining: the steps requisite to be taken
in places where small-pox is prevalent. Needless to say, all these recommendations were duly
carried out.
Notification of Chicken-pox.—The Board also suggested the desirability of adding chickenpox,
either permanently or temporarily, to the list of notifiable diseases, with the view of " affording
the Medical Officer of Health the means of detecting possible sources of small-pox infection,"