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27
[1926
It is this second case which has been allocated to Islington, the first having been
allocated to St. Pancras, where the woman's ordinary residence was. The home
address of the second case, that is, the one allocated to Islington, was in the
Borough of Hornsey, where the woman resided with her husband, but she had
been many months in hospital, and for a short interval at " Grovelands," The
Hospital " Home," in the Urban District of Southgate.
The system adopted in the primary case at the Royal Northern Hospital was
to isolate the patient in a side ward at once until a definite diagnosis was made.
The history of the Paris visit was not known until the case was being particularly
enquired into. When smallpox was definitely diagnosed, in addition to the side
room, the ward the patient occupied was immediately placed under quarantine
and kept isolated from the rest of the hospital. The Public Vaccinator was the
same evening called upon to vaccinate every case in this ward and members of
the staff and others particularly selected in the hospital on the following days.
It was fortunate that the particular ward was practically self.contained, and this
isolation of a portion of the hospital could be carried out. The hospital, of
course, suffered by the necessary restrictions which had to be imposed, as it
would have been unwise to have admitted any fresh cases that could be avoided,
and a very careful watch had to be kept on all patients while there was still
any risk of these showing symptoms.
The occurrence of only a single case from the infected" patient introduced
into a large hospital is, I think, a matter for congratulation, for notwithstanding
the great care of the hospital authorities, their extra work, and that which
devolved upon the Public Health Department, it would be difficult to ensure that
even the great precautions would have such an excellent result in view of the
number of visitors to such a large institution and the risk that some infected
person might escape detection. Although there were a few false alarms and
some cases kept under very persistent supervision, there was not any person
infected but the one.
The Ministry of Health, when the complicated illness of the first case was
under consideration, very kindly lent the assistance of Dr. Sturdee, and the
London County Council, Dr. Wanklyn, and these experts continued to attend
until the only infected case occurred and the safe period had passed.
I need hardly add that the assistance the Medical Officer of Health received
from the Public Vaccinator, Dr. Fagan, from the Resident Medical Officer in
charge of the ward, Dr. Innes, his assistants, and the staff of the hospital, enabled
the good results to be obtained, while the great extra work which was thrown
on my department was done ungrudgingly by the inspectors, clerks and staff
generally, who gave much overtime and worked hard to round up the contacts
and keep in touch with them.
In the large number of vaccinations done by the Public Vaccinator, a point
arose which is of considerable scientific interest. During the War, as may be
known, the practice of the use of iodine solution for sterilizing the skin became
fairly common. Such is the routine method of sterlizing the skin before the
injection of vaccines, for instance those used for protection against typhoid and
cholera, but for ordinary vaccination done by scarification one of the best methods
of cleansing the skin; is to wash the part with ether soap solution. Inadvertently
in some cases prepared for vaccination the nurse had used the iodine method, and
it was found that the effect of the iodiine in destroying the efficiency of the vaccine
lymph is marked. These cases, when the effect was discovered, were
re.vaccinated.