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had to be kept on persons who had been exposed thereto for about sixteen
days, unless such persons had been protected by successful recent
vaccination before exposure to infection, in which case no observation
was necessary. By means of the system which was inaugurated by the
Metropolitan Medical Officers of Health, lists of such "contacts" were
daily exchanged, generally by telephone as well as in writing, and thus
many cases were detected which might otherwise have escaped notice,
and would have acted as fresh centres for the diffusion of the complaint.
I find that the names of no less than 5,785 persons have been recorded as
"contacts," and, in addition, there have been a vast number of persons with
whom infected persons must have come in contact in shops, streets, and
places of assembly; 55 of the above were notified from port sanitary
authorities, and 57 were persons who had been visitors to the Small-pox
Hospital. In all but two instances these were re-vaccinated at the time
of their visit, and none of them contracted the disease.
The Public Health Committee were of opinion that it should be a
condition that persons allowed to visit patients in the Small-pox Hospital
should have been recently re-vaccinated. This view was considered
by the Metropolitan Asylums Board on January 25th, but they did not
feel themselves strong enough to adopt it. They explained that every
visitor to a patient was strongly pressed to be vaccinated, and that they
would in future take the precaution of forwarding the names and
addresses of all visitors, whether they accepted vaccination or not, to
the Medical Officer of Health of the district in which they resided.
A certain proportion of persons who had been in "contact" with
cases of small-pox were found to be unvaccinated; as promptly as
possible they were vaccinated if they would permit it to be done, and a
considerable number of persons must have been protected thereby, as in
no case did an unvaccinated person who had been exposed to infection
escape, and 64.7 per cent. of them died. Among those who were vaccinated
some days after receipt of infection little good was expected to
ensue, but the death-rate among such was 40 per cent., and the disease
ran a milder course.
As the question had arisen as to the action which local authorities
should take in order to deal effectively with the inmates of dwellings
invaded by small-pox, the Local Government Board thought it desirable
to state (22nd February, 1902), that " they are advised that, under
ordinary circumstances, the quarantining at their homes of inmates of
such dwellings is not necessary in districts in which sanitary matters
are properly administered, and vaccination and re-vaccination are
efficiently carried out. If, on a dwelling becoming invaded by smallpox,
the actual patients are at once removed to hospital, the dwelling
and all articles in it that have been exposed to infection, including the