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34
There are two dangers which threaten to bring vaccination into
disrepute, i.e. the use of inert lymph and the practice of one mark
vaccination. These two dangers can and ought to be guarded against
by the action of the Local Government Board.
The compulsory vaccination of the infant community, and compulsory
re-vaccination at from 10 to 15 years of age, would practically
stamp out the disease. It is not fair, therefore, that the community
should have to face the present double expense of vaccination and
isolation, and quarantine, for the sake of a minority who are either
careless or faddy. Until a regular system of re-vaccination is introduced
into London, it will be necessary to provide for the accommodation
of large numbers of patients, and the other great expenses
of Small-pox outbreaks will have to be borne by the community.
Doubtless mild unrecognised cases are responsible for the spread
of the disease, and have played no small part in maintaining the
present outbreak. The patient in his most infectious stage may be
hardly sensible of any illness. It is difficult to see how this source of
infection in epidemic periods can be adequately guarded against.
In doubtful cases the tendency is to throw upon the Medical
Officer of Health a responsibility for diagnosis which does not properly
attach to his office, and which during the present outbreak has involved
the expenditure of much of my time. But an early and correct
diagnosis of infectious disease is a matter of such urgent importance
that in my opinion a Medical Officer of Health can afford to neglect
much of his other work in order to assist in this, and it is to his own
interest and that of the community for which he acts that he should
do so.
In connection with the outbreak of Small-pox in the Metropolis,
the desirability of making the notification of Chicken-pox compulsorily
notifiable was considered at an early date. Personally, I was not
disposed then to attach great importance to that step as a
preventive measure. In January of the present year, 1902,
however, the London County Council resolved, under Subsection
V. of Section LV. of the Public Health (London) Act, 1891, to
order the compulsory notification of the disease in the Metropolis