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1928
29
about 10 years past. The whole question of Small-pox and
vaccination is profoundly influenced by the prevalence in the
country of what is officially designated "Mild Small-pox."
There are at present 2 schools in the medical ranks, whose views
are diametrically opposed as to the character of this mild
disease, the Dualist and the Unicit.
The Dualist view is that so-called Mild Small-pox, though
closely related to classical Small-pox, is for all practical purposes
a different disease from Small-pox. According to this view, this
non-virulent disease, known in America as Alastrim and in Africa
as Amaas or Kaffir-pox, is not true Small-pox at all, but another
epidemic disease closely resembling but distinct from it. Moreover,
it is contended that each has its own clinical characteristics
which in many cases at least, enable the two diseases to be
identified.
The official view is that mild Small-pox and classical
Small-pox are one disease, showing differences in epidemic
virulence. The distinction between cases of sub-toxic Small-pox
and cases of a more severe type cannot be made on clinical
examination of individual cases, but only by taking account of
associated conditions and the subsequent course of events. That
is to say, differentiation of the sub-toxic from the toxic type of
the disease is necessarily retrospective, and retrospective
differentiation is the only safe course.
These arguments are of certain academic and scientific
interest, but apart from that they have little bearing upon the
all-important factor of prevention, because everybody admits
that recent vaccination protects against both mild and severe
Small-pox. From an administrative point of view it matters very
little whether the mild form is the same as severe Small-pox or a
separate disease. The difficulties of control arise from the very
mildness of the symptoms. Because of the trivial character of
many of the cases, many of the cases easily escaped detection,
and some of the public refused to treat it seriously after they
become familiar with it. For these reasons the disease has, in
certain areas, proved most intractable.
We were fortunate, not because of the attitude of the
contacts towards the disease, but because other circumstances
were favourable. Where the first case was discovered, most of
the contacts were at once examined and advised to be vaccinated.
Only one consented. When the later cases occurred not one
was re-vaccinated. The man who was re-vaccinated had a painful
arm, and was unable to follow his usual occupation. He went
to the Guardians for relief, but was told they had no power to
relieve him in the circumstances. Reports also were circulated.