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19
Measles and German Measles.
Only 501 cases of these diseases were notified in 1919, as compared
with 1,057 cases of measles, 93 of German measles in 1918.
a deaths only were recorded as due to measles, none to German
measles.
Enteric Fever.
Only 5 cases were notified during the year, as against 17 in
1918. No deaths occurred.
Smallpox.
9 cases of smallpox occurred in Croydon during the year.
The infection was introduced by a demobilised soldier (an
R.A.M.C. man), who had been in contact with a case of smallpox
in a troop train travelling from Taranto to Le Havre. He arrived
home on April 12th, and the first case developed in the person of
his wife on April 25th. He himself never had the disease. Six
cases in all occurred in this family, but one of them—a girl in
domestic service—turned ill in her employer's home in the neighbouring
district of Penge. Of the other four cases, two occurred
in the house adjoining that occupied by the original cases, and the
other two in the persons of the doctor who first attended the cases
and his wife. Two of the cases were unmodified smallpox in
unvaccinated children—both were exceedingly severe and confluent
in type—one died (the only fatal case) and the other escaped
death bv the narrowest margin. The other cases were modified
smallpox, the patients having been vaccinated in infancy. One
case was vaccinated after having been infected and ran a very mild
course—the rash consisting of only three spots.
Energetic measures were taken to quell the outbreak. Vaccination
or re-vaccination was offered to all those who had been in
contact with the disease. Also the whole staff of the Public Health
Department, including the staff of the Borough Isolation Hospital
and those who required it at the Smallpox Hospital were revaccinated.
All contacts were kept under daily supervision.
Rigorous disinfection was carried out. The Ministry of Health
and all neighbouring medical officers of health were kept informed
of the details of the outbreak. The cases were treated at the Smallpox
Hospital, Cheam, under myself as the temporary Medical
Superintendent. It was this outbreak which caused the delay in
opening Cheam for tuberculosis.
It is of vital importance that the attention of the public be
once more directed to the need of vaccination in infancy and of
re-vaccination in adolescence. Vaccination is the only protection
against smallpox, and the great increase in the number of exemptions
constitutes a grave menace to the public health.