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13
SMALL-POX.
During the year I received only two notifications of small-pox only one of which was a
genuine case of small-pox, in comparison with 218 notified in 1902, and 211 in 1901.
The first was that of a "tramp," a male 41 years of age, who stated that he had tramped
from Manchester through the Midlands, and was removed from the Casual Ward in Little Grays
Inn Lane.
The other case notified was that of a male 6½ years of age. I was asked by the doctor to
see the patient before removal, and on making a careful examination I found that the child was
suffering from chicken-pox and not small-pox. I wrote to the doctor my opinion of the case and
he afterwards wrote to me that he was then also of that opinion that it was chicken-pox. This
doctor had had a fair experience of small-pox. I mention this as an illustration of the great
difficulty there is in the diagnosis of many cases of small-pox and chicken-pox.
I was also asked to examine various other doubtful cases of small-pox, but I was of the
opinion that they were really cases of chicken-pox and they were not removed to hospital.
The notifications in London were:—l9o3, 417 cases; 1902, 7,796 cases; 1901, 1,702 cases.
THE GREAT IMPORTANCE AND VALUE OF SUCCESSFUL VACCINATION
AND RE-VACCINATION.
Necessity for a Re-vaccination Act.
In my Annual Report last year I gave various facts and statistics showing the great importance
and value of successful Yaccination and Re-vaccination, and also resolutions adopted by the Incorporated
Society of Medical Officers of Health in connection with the proposed new Yaccination and
Re-vaccination Act.
Conflicting statements having been made from time to time in the Public Press as to the
methods employed in Germany in dealing with small-pox patients, the President of the Local Government
Board determined to obtain through his medical staff, information, collected personally in Germany,
of a sort to enable him to contrast the actual methods employed there with those existing in England
and' Wales. This mission was entrusted to Dr. R. Bruce Low, Medical Inspector of the Local
Government Board, and he visited ten of the principal towns in Germany during the autumn of 1903,
and conferred with the physicians of the hospitals, inspected the accommodation provided for small-pox
patients and obtained also information from the Central Imperial Health Office, Berlin.
In Germany all persons suffering from small-pox or suspected to be suffering from small-pox
can be ordered to hospital for isolation, if, in the opinion of the medical adviser of the local
authority the patient cannot he isolated at its home, and on the occurrence of a case of small-pox in a
house "contacts" are immediately vaccinated or re-vaccinated.
During the twelve years 1891 to 1902 inclusive, in Germany with a population in 1900 of
56,367,178, the number of recorded deaths from small-pox was 607; in England and Wales with a
population in 1901 of 32,526,075, the number of registered deaths was 6,761; thus in the twelve
years in Germany there were less than 11 deaths per million of the population in comparison with
208 in England and Wales, or in other words, the small-pox mortality was about twenty times more
in England and Wales than in Germany.
Dr. Bruce Low thus sums up his most valuable report:—
" From the account above given of the methods employed in Germany for isolating small-pox
it will be obvious that the general plan followed differs markedly from that employed in this country.
Almost always in Germany small-pox cases are isolated on the site of the general hospital, and, as
often happens, when the occurrence of small-pox in a given place is rare, the small-pox pavilion is not
allowed to stand empty, but is used for the accommodation of other cases, infectious or non-infectious.