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43
The Board's
letter of
9th August]
1918.
The following is the reply received from the Board:—
9th August, 1918.
Sir,—With reference to Sir Robert Blair's letter of the 11th ultimo, I am directed to state that
the Board are glad to learn that the various questions raised in their letter of the 27th March last are
receiving the consideration of the Council, and that in certain directions some action is being taken.
They will be glad to learn in due course what is decided in regard to those questions which are stated
to be still under consideration.
The Board are strongly of opinion that the Council should not restrict their consideration of the
problems of their school medical service to what is practicable within the limits imposed by existing
abnormal conditions and circumstances, but that they should take an early opportunity of reviewing the
whole of their arrangements with a view to the adoption of a broad policy of reconstruction and development
as soon as more normal conditions are restored.
For the moment the Board do not consider that they can usefully add to the full statement of their
views which was contained in their letter of 27th March last. There are, however, a few points raised in
Sir Robert Blair's letter which may be briefly referred to—
(а) The Board fully concur with the view of the Council expressed in paragraph 3, that the
work of inspection clinics should not be divorced from that of treatment centres. As stated in
paragraph 4 of their letter of the 27th March, they considered it especially important that the
work of inspection clinics should be closely allied with that of minor ailments centres. What the
Board desired to emphasise was that the end in view would not be attained if the establishment
of inspection clinics at treatment centres tended to congestion and to interference with the
. efficient working of the centre.
(b) In answer to the inquiries made in paragraphs 5 and 9 of the letter, I am to inform
the Council that the references made in the Board's letter of the 27th March to the possibility of
delay in following up cases of measles and in the supply of milk, were based upon information
furnished to the Board's officers during their inspection, the evidence of which of course is in the
possession of the Council and not the Board. I am to add that the Board's officers did not take
particulars of such cases, but the Board are assured that if the authority will examine the returns
in their possession they will find that the statement as to the possibility of delay is fully justified.
(c) As regards the provision of spectacles dealt with in paragraph 7 of Sir Robert Blair's
letter, while it may not be practicable for the Council under existing conditions to secure that a
larger proportion of the children who require spectacles actually obtain them, the Board cannot
regard the present position as a satisfactory one. The question is in some respects closely allied
with that of the maintenance of an efficient system of " following up."
(Signed) E. H. Pelham.
Smallpox.
Infectious Diseases.
An outbreak of smallpox occurred during the months of March and April, mainly in the East
End. On the 2nd March, a case was discovered in Stepney, and the same day four additional cases
were found in neighbouring houses. The patients were at once removed to hospital, and all precautions
were taken, including vaccination of contacts, and their removal to the borough council's shelter for
observation. Subsequent investigations brought to light two further cases during the next few days
in the same area. The rash in each instance had appeared some days before the case was discovered.
On the 5th March, Dr. Brincker, one of the Council's smallpox experts, was asked to see a man
(H.W.) aged 33, of 71, Albion-road, Hackney, and found that he was suffering from smallpox. It was
ascertained that the patient was the undertaker who made arrangements for the funeral of the original
sufferer in Stepney, by whom he was no doubt infected. The patient's wife and child contracted the
disease during the course of the next two weeks. On the 6th March a case was discovered in Bethnal
Green in the person of one of the female employees (aged 17) at the Sussex Laundry, Commercial-road,
where it was stated some of the washing from Stepney was dealt with.
From 12th to 14th March, eight contacts in the borough council's shelter were removed to
hospital, and there is no doubt that the prompt detection and removal of these and other cases later
on whilst under observation at the shelter averted a more extensive outbreak and possibly an epidemic.
A total of 34 cases occurred during the course of the outbreak, including 24 in the Borough of
Stepney, 3 in Ilackney, 2 in Poplar, 2 in Bethnal Green, 1 in Deptford, 1 in Lambeth, and 1 in
Islington. All the cases which occurred outside the Stepney area were attributed, directly or indirectly,
to the original focus of infection, and owing to the prompt measures taken the outbreak was restricted.
Only 8 out of these 34 cases were elementary school children, and of these two attended St. Mark's
School, Royal Mint-street (Whitechapel), two were at Tower Hill (R.C.) School (Whitechapel), one
each at Somerford-street (Bethnal Green, S.W.), Queen s-road (Hackney, C.), Malmesbury-road (Bow
and Bromley), and Fairclough-street (St. George's-in-the-East). No secondary cases occurred among
the pupils at these schools; in fact, in only one out of the eight school cases referred to above was it
possible for the child to have been infectious when last at school prior to removal to hospital. Vaccination
was widely offered to. the pupils and staff of the schools, as well as to large numbers of other
inhabitants in infected areas, who freely availed themselves of the facilities thus afforded. There is
no doubt that this protective measure, by immunising a considerable proportion of the local population,
was in part instrumental in suppressing the outbreak. All the schools in the neighbourhoods affected
were kept under close observation by the Council's medical staff, and special attention was paid
to the following-up of absentees in co-operation with the borough medical officers and the school
attendance staff.
50129 d 2