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43
Roughly, it has been found that about one-half the doubtful cases of fever
or eruption are cases of Small-pox, about one-fourth are cases of Chicken-pox,
and about one-fourth are distributed amongst a number of other diseases.
Attention must be called to the fact that clinical examination precedes
certification, and it follows that the more careful and correct the clinical
examination the fewer will be the number of cases of Small-pox diagnosed as
Chicken-pox.
When a certificate of Chicken-pox is received a copy of the certificate is
sent to the vaccination officer with a slip attached stating that " the
Medical Officer of Health desires to know whether this patient, under 10 years
of age, has been vaccinated, and when and with what result," or to the
medical attendant with a slip stating that "the Medical Officer of Health
desires to know whether this patient, over 10 years of age, has been
re-vaccinated, and if so, when and with what result." As only about eight
per cent, of Chicken-pox cases occur at ages over 10 years, about eleven
out of every twelve cases are referred to the vaccination officer.
These preliminary measures are important in the discovery and recognition
of the disease, as it is well known that one unrecognised case of Small-pox will
often spread the disease directly and indirectly to ten, twenty, thirty or more
persons. Each case of Small-pox costs many pounds, whereas these preliminary
measures for preventing the spread of the disease do not cost as
many shillings.
As soon as a case of Small-pox is diagnosed, further measures are promptly
taken. The medical practitioner forthwith sends the notification certificate
to the Medical Officer of Health, who immediately puts the preventive
machinery into motion. A copy of the certificate is left at the house for the
ambulance nurse, and a message is sent to the hospital for the immediate
removal of the patient. Notices are sent to the person in charge of the patient
as to the mode of procedure, and as to the law in reference to exposure,
removal to hospital, disinfection, &c., as this prepares the way with suitable
information, and much facilitates the work o† nurse, inspector, and disinfector.
Copies of the ceitificate are sent to the public vaccinator and vaccination
officer, and they must, in accordance with the special instructions of the Local
Government Board, re-issued March, 1901, clause 3, make inquiries as to
vaccination from room to room and house to house.
The Sanitary Inspector proceeds to the house with an inquiry form, and
obtains information as to the occupation of the patient, and the school (including
Sunday school), workplace, or office attended, the dates of last attendance,
of falling ill, of appearance of rash, and of removal to hospital, and the
laundry used. Also the names of all the schools (including Sunday schools)
attended by all the children in the house, the occupations of all the adults,
and addresses of the workplaces or offices attended. He prohibits any linen
of the patient or of the family being sent to the wash before disinfection, also
the cleaning, repairing, or making of any clothing or furniture materials in
the house, and gives instruction for any in process to be disinfected. He also
forthwith prohibits all children in the house from attending school. Members
ot the family and persons in the house are dealt with as contacts.