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10
Air transport has the effect of bringing persons suffering from
infectious disease into the country prior to the close of the incubation
period and, therefore, prior to the onset of any symptoms. Thus the
danger now of undiagnosed smallpox or other disease such as typhus or
cholera associated with the Middle East and Asiatic countries, is much
greater than when these diseases occur on board ship, where the chance
of symptoms developing during the voyage and their subsequent
discovery either on the voyage or at the port was most likely and this was
a very great safeguard.
Three smallpox contacts from air-borne cases were kept under
observation during the incubation period in Stoke Newington.
The Brighton epidemic, which caused several deaths, arose from
airport travel. Some doubt arose in this connection as to whether a case
of smallpox had occurred in the Borough but the diagnosis of measles
was finally made.
Ship travel, from the public health point of view, has another
advantage, since many passengers travelling on a ship are willing to
receive vaccination immediately discovery is made of a case of smallpox,
as for instance occurred in the case of the S.S. Mooltan, which arrived
in the Port of London with the body of a person who had died of smallpox.
Twelve cases of confirmed or doubtful smallpox of persons who
had been recently vaccinated were subsequently removed to hospital in
the London area and four deaths occurred. Some London Boroughs had
a considerable number of contacts to keep under observation, in one
instance as many as 25. Stoke Newington was fortunate in this instance.
The borough has been very fortunate in that the actual epidemic
outbreaks have been so few, but there have been numerous occasions
which might have given rise to epidemics if the administration had not
been in adequate working order.
Every year, for instance, smallpox contacts are kept under
observation and, although the number of such contacts who have
developed smallpox has been very small, each one of these might have
been the cause of a serious outbreak.
The same applies to typhoid fever since there has seldom been a year
in which one or more cases have not occurred and each one of these was
obviously the potential source of an epidemic.
Very little is known about the causes which give rise during one year
to an epidemic, while in other years the occurrence of several cases of
such conditions as cerebral meningitis and poliomyelitis may do little
harm. Where the means of spread of a disease is actually known as, for
instance, the spread of typhus by the louse, the public health administration
can prevent an outbreak with reasonable certainty and with almost
the same certainty such a disease as typhoid, which is, of course, an
entirely different and less dangerous disease than typhus, which was the
old jail or camp fever and a disease which has destroyed armies.