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The course of action adopted in these separate classes is as follows : —
Cases of Smallpox Residing in the Borough.—Upon receiving a notification
of smallpox, the premises are visited, arrangements made for the removal
of patient to a hospital of the Metropolitan Asylums Board, the room or
rooms disinfected, the bedding and clothing removed and disinfected at the
Council's disinfecting station. The names, ages and place of employment or
schools attended, together with the vaccinal condition of the contact, and any
other information which may be useful are obtained. The schools attended or
the Medical Officers of Health of the Borough in which they are employed are
notified.
Arrangements are made for the Public Vaccinator to attend to vaccinate or
revaccinate all contacts. It is usual, and in some cases imperative, for the
Sanitary Inspector to be in attendance to assist the Public Vaccinator and to
influence the contacts.
For instance, a case occurred in Goldsmith Buildings, a building consisting
of a number of separate tenements occupied by 27 families containing 92 people;
here, owing to the irregular hours in which by the nature of their employment
they could be found at home, a number of visits had to be made to interview the
occupants. Eventually, however, almost all the contacts were revaccinated or
primarily vaccinated by Dr A. E. C. Hallen, the Public Vaccinator of the
District, and no secondary case occurred. The last item of the procedure is to
visit all contacts daily for 19 days and to report any suspicious case of illness to
the Medical Officer of Health.
Cases of Smallpox Working in the Borough, but Residing Elsewhere.—
These patients have in most cases been working in the Borough until the day
before or until the day of their removal to hospital, so that they must be dealt
with as actually occurring here; therefore the premises and contacts are dealt with
in the same way as those in the above class.
The Medical Officers of Health of the areas in which the contacts reside are
notified; in as many instances as possible arrangements are made for the Holborn
Public Vaccinator concerned to attend at place of work. Owing to the fact that
usually there are a large number of contacts the Public Vaccinator often has to be
helped; the Medical Officer of Health and as many disengaged medical friends
as he can get together, the Sanitary Inspectors and part of the clerical staff of
the Public Health Department are pressed into service. This is done in order to
strike while the iron is hot, when there is little or no objection to vaccination.
In some firms the number of contacts have been large—260, 175, 167, 161
and 68; practically all were vaccinated or revaccinated. In some of these
instances these numbers represent the employees of one firm; in others the large
numbers are made up of the employees of many firms working in the large double
or even triple buildings found in the important business streets of the Borough.
We have had in several instances to thank managing directors, directors, and chiefs
of staff for setting an example and being the first to be vaccinated. Any suspicious
illness among the employees within the period of danger can be gone into by the
Medical Officer of Health. In one firm an errand boy was found to be suffering
with smallpox; subsequently his two sisters, contacts in the home, were also found
to be suffering from smallpox.