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12
Annual Report of the London County Council, 1914.
Smallpox.
The death-rates from smallpox in successive periods are given in table I, page 40. The smallpox
death-rate in each year since 1840 in relation to the mean death-rate during the period 1841-1914
is shown in diagram (F). The cases notified per 1,000 living since 1890 are given in table II,
page 41.
It was feared that, owing to the abnormal conditions created by the war, there would be danger of
the introduction and spread of cases of smallpox in this country. Notwithstanding these exceptional
circumstances, only one case of smallpox occurred in London during the year, and this was notified on
19th February. The patient was staying in Newgate-street, E.C., when smallpox developed. He was an
engineer on board the s.s. Avon, which arrived at Southampton on 7th February from Pernambuco
(Brazil), where smallpox was prevalent. The infection was, therefore, derived from abroad. A surgeon
on the s.s. Avon, who had been attending a case of smallpox on board, had been removed to South Wharf
several days prior to the engineer referred to above, on suspicion of smallpox, but he was
discharged after four days detention as not suffering from the disease. All necessary precautions were
taken and information was circulated to the medical officers of health of the metropolitan boroughs.
There were no developments. Requests for the services of the Council's staff in consultation were made
in 26 doubtful cases; the patients were examined either by Dr. Wanklyn or Dr. Brincker, but only in the
case already mentioned were the suspicions of the medical attendant confirmed.
Two cases of smallpox were landed in January from vessels arriving in the Port of London, and
were removed to the Port Sanitary Authority's hospital at Denton. The patients were members of
the respective crews. One of the vessels had come from Smyrna and the other from Barcelona. In
one case another member of the crew was removed to Denton Hospital with suspicious symptoms, but
was subsequently discharged as not suffering from smallpox. The crews of both vessels Were vaccinated,
and remained on board until the vessels re-sailed. The information was circulated, and the medical
officers of health of the ports of destination of the ships were also informed. A further case of smallpox
was reported on board a vessel arriving in the Port of London in February. The patient had, however,
been landed en voyage at Gibraltar. The names and addresses of the passengers and crew, giving
London addresses, were forwarded to the local medical officers of health concerned..
During the year the names and addresses of persons proceeding to London from ships which had
arrived at Liverpool, Plymouth and Southampton, with cases of smallpox on board, were received from
the medical officers of the Port Sanitary Authorities concerned, and arrangements were made for these
persons to b3 kept under observation. Special attention was given by the Council's inspectors to persons
who proceeded to common lodging-houses.
The question of the prompt notification of cases of smallpox to the county medical officer of health
by medical officers of health of the metropolitan boroughs and port sanitary authority was recently
the subject of correspondence between the Council, the Local Government Board and the metropolitan
boroughs. The Council had approached the Local Government Board representing that in view of the
steps which experience had shown it was desirable should be taken to safeguard the health of London as
a whole, it was a matter of extreme importance that the Port Sanitary Authority, the City Corporation
and the metropolitan borough councils should arrange to give the earliest possible notification to the
county medical officer of health of the occurrence of smallpox, plague and cholera. As a result, the
Local Government Board, in August, 1914, expressed the view that in their opinion each single case
of smallpox, plague or cholera should be regarded as an outbreak of dangerous epidemic disease requiring
to be notified immediately to the County Council, and in addition to formal notification, there should
be an interchange of more detailed information subsequently elicited. The Local Government Board
communicated in this sense with the Port of London Sanitary Authority and each metropolitan borough
council.
In August, 1914, a memorandum was circulated to sanitary authorities by the Local Government
Board on the precautions generally to be adopted in the event of smallpox being imported into the
country. The memorandum deals in detail with the steps to be taken when a case of smallpox is notified,
the provision of hospital accommodation, disinfection, vaccination and re-vaccination of contacts,
tracing and surveillance of contacts. With regard to contacts it will be of interest, as bearing upon
the correspondence with the Local Government Board referred to above, to quote the paragraphs in
the memorandum dealing with the matter. They read as follows —
"If any contacts have removed to another area, the medical officer of health of that area
should at once be informed. If, for any reason, it is feared that the list of contacts is incomplete,
a house to house visitation may be desirable in the neighbourhood in which a case of smallpox
has occurred, to make inquiries as to suspicious illness and to advise vaccination or re-vaccination.
If further cases are feared, common lodging-houses and other collections of itinerant persons
should receive special supervision.
In view of the fact that smallpox is now commonly derived from abroad, all notifications
from port medical officers of health as to persons arriving in a given area from ships on which
cases of smallpox have occurred should receive the same attention as is given to local contacts."
A further memorandum applicable to London only was also issued "on the steps specially requisite
to be taken in places where smallpox is prevalent," the principal features of which were insistence upon
the importance of prompt measures with regard to vaccination being taken by the Board of Guardians,
and upon the obligations of local sanitary authorities under the Public Health (London) Act, 1891.