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30
SMALL-POX.
In the "Final Report of the Medical Officer of Health upon the small-pox
epidemic of 1901-2 in St. Pancras and London,"dated 7th January, 1903,
and printed in the Minutes of the Council, of the 14th January, there appeared
a complete history of the epidemic, together with full statistical tables. The
main facts brought out in that Report were—
1.—That there was no decided and permanent fall in the small-pox
morlality in London until after the year 1885, and the Metropolitan Asylums
Board had removed the Small-pox Hospitals out of London.
2.—That although the utmost promptitude in removal to Hospital was
practised in those cases diagnosed or suspected to be small-pox, yet the delay
in other cases in the recognition of the symptoms, and in the seeking of
medical advice by patients, or by persons in charge of them, and also in the
mistaking of small-pox for chicken-pox, and other disease'', were large factors
in the spread of the disease amongst a susceptible community, even when the
small-pox Hospitals had been removed to a distance from the Metropolis.
3.—That the proportion of cases notified and of deaths certified during the
previous six years in London, showed that the case fatality per cent, was
rising, and that the gradually increasing number of unvaccinated persons,
with the consequent accumulation of a more and more susceptible population,
culminated in the epidemic of 1901-2.
At the commencement of the epidemic the earliest local outbreaks in several
parts of London appeared in a number of instances to be due to unrecognized
cases, probably imported from abroad, especially Paris, and manifested themselves
amongst laundry workers handling dirty and probably infected linen,
and amongst persons in contact with travellers and others suffering from
symptoms to which no attention was paid, or which were erroneously regarded
as less serious eruptions, especially chicken-pox. Experience further showed
how difficult it often was to recognise modified small-pox, how numerous were
the doubtful cases, and what great opportunities small-pox thus possessed of
spreading unsuspectedly and uncontrolled through a susceptible community.
The course of the epidemic demonstrated the necessity for four series of
precautions apart from vaccination, for the prevention of the spread of smallpox—
(A) the prompt finding and recognition of small-pox cases, (B) the rapid
dealing with cases when discovered and diagnosed, (C) the dealing with
persons in contact as to their health, cleanliness, and clothing, and (D) the
better isolation of small-pox Hospitals.
These series of precautions indicated the requirement of the following
measures:—
(A.) Discovery of Small-pox Cases.
1.—The disclosure of suspicious eruptions by the notification of chicken-pox
by patients, or persons in charge, when small-pox threatens.
2.—The confirmation by further medical examination, and at least a second
opinion, of doubtful cases, before pronouncing them definitely to be "not
small-pox."