View report page

By the middle of March an alarming increase in the disease was evident. Tents were erected beside
the hospital. The Vice Chairman of the Council became a victim, but fortunately recovered. The
jury at an inquest were excused from kissing the Bible by the Coroner in deference to their fears of
infection. The March total was 115 cases. In April it fell to 81. A tent at the smallpox hospital
used for drying was burnt down. A local clergyman said that he had been practically boycotted by
his parishioners because he had visited the smallpox hospital. Parents had threatened to withdraw
their children. He was determined not to cease attending the hospital, and had taken rooms away
from his house in order to avoid a risk of infection.
At the end of April it was thought that the epidemic was abating, but May was the worst month,
reaching 129 cases. The Council agreed a shilling rate to pay for the cost of the outbreak. In
June the number fell to only 39, but there were 11 deaths in the same period. Presumably many of
these had taken ill the month before. After this the incidence declined rapidly. The total number
of cases in the epidemic was 525, 74 of whom (14 per cent) had died.
The editorial of 1st August stated that there was little room to carp at what the local authority had
done in the face of the ordeal. The Health Department had worked under great difficulties, not the
least of which had been a series of changes at the top. The former Medical Officer of Health had
been succeeded by a temporary one, who had unfortunately died a few weeks after. His successor
had been young and inexperienced; but then came the appointment of Dr. Butler-Hogan. By July it
was clear to the readers of 'The Tottenham Herald' that he was a man of strong personality who did
not hesitate to express his views. He wanted an infectious diseases hospital for Tottenham. In
September he criticised the general public health provision for the area. Indeed, his appointment
signalled the beginning of a series of striking advances in the health of Tottenham, which were to
become evident over his tenure of office during the next ten years.
His Report on the epidemic, unlike many medical documents, stands the test of time well. A modern
reader who is experienced in the subject cannot but be filled with admiration for the author, most of
whose statements could be transferred wholesale to a modern textbook without seeming out of place.
The Report was written with one definite object: to place the facts about smallpox and vaccination
firmly before the Council, dealing with the controversial points one by one, in sufficient detail to
make his arguments clear.
"I can well believe", he wrote, "that with all the conflicting and inaccurate statements which are
made about vaccination, you must find it difficult to arrive at any sound conclusion on the subject".
He went on to prove by the use of statistics on hospital staff that vaccination conferred a very high
level of protection, even for those in direct contact with patients. As for the community in general,
he showed that claims that it was ineffective were not confirmed by the evidence. Smallpox could
occur in adults who had been vaccinated in infancy, but this was because their immunity had been
allowed to decline. Revaccination would have given them considerable protection. "in the case
of Small Pox", he said, "there is no substitute, and if you discard Vaccination, you are left
defenceless and without any protection but flight in the presence of a relentless foe". This is
almost as true today as it was then. He went on to say: "...it might be expected that those who
wish to learn about Smallpox and its prevention would be wise to go to those likely to possess the
most accurate knowledge of the disease, namely, those who have spent their lives in the practical
study of Small Pox. You will find that the unanimity of opinion expressed by those (who have so
spent their lives) as to the effect of Vaccination is very striking, and those who have been opposed
to Vaccination are either those who have no very practical acquaintance with Small Pox, or whose
eyes have been so completely blinded by preconceived prejudice as to be incapable of seeing aright.
There are, unfortunately, armchair generals even in medicine, who prefer to sit at home and deal
out what they consider destructive criticism to those who are in the midst of the fight, rather than
be up and doing something for the good of the individual and the welfare of the community".
"The fight against ignorance and prejudice is not over", he said in his concluding paragraphs, a
statement that could be echoed nowadays. The anti-vaccinationists are still with us, and producing
the same arguments as before. But in spite of their opposition great progress has been made.
This country has probably benefited most from the massive vaccination campaigns run by the World
Health Organisation in under-developed countries, so reducing the dangers from foci of infection
abroad. But these are far from complete and present appalling difficulties to those who have to
organise them. The development of fast air travel has brought the problem much closer to us, but
this has to some extent been controlled by strict enforcement of vaccination regulations for travellers.
In Haringey this involved Health Department staff in the surveillance of 34 insufficiently protected
14