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20
The disease ha- been of mild type. There were no deaths from smallpox in
Shoreditch during the year under consideration, and onl\ six in London.
The administrative measures to he taken by Sanilary Authorities on the
occurrence of eases of smallpox are set forth in Memo. 71 a/Med. issued by the
Ministry of Health in 1022. These include : verification of diagnosis, removal of
patient to hospital, vaccination and surveillance of contacts (i.e., those who have been
exposed to infection), disinfection, and search for source of infection.
With the exception of vaccination these measures were satisfactorily carried out.
The state of public opinion in the Borough regarding vaccination, however, is such
that it was only possible to persuade comparatively few of the contacts to be
vaccinated, and the failure of great administrative efforts to check the disease must
be in a large measure attributed to this fact. The extreme mildness of very many
of the cases undoubtedly added to our difficulties. Numbers of cases only sought
medical advice after they had been spreading infection for several days, and there
were undoubtedly cases that never went to see a doctor at all, and were consequently
a source of infection until they recovered.
Of the administrative measures referred to, that of the surveillance of contacts
is the one in the carrying out of which the greatest difficulties were encountered.
These difficulties are so serious as to warrant special consideration.
It is explained in the Ministry of Health Memorandum referred to above that
there is no necessity to isolate smallpox contacts in their homes, but that they should
be kept under observation and allowed to continue at work. Many employers,
however, could not be persuaded to adopt this course, but insisted upon employees
remaining away from work, often without pay, so long as they were on the list of
contacts, that is, until eighteen days after the last exposure to infection. In not a
few instances individuals were dismissed altogether, and thus found themselves out
of work as a result, though an unnecessary result, of the administrative measures
taken to control the epidemic. Interruption in, or loss of, employment are matters
of such grave importance to the health and well being of the families concerned that
it may be asked whether the results achieved have been sufficiently good to justify
the means adopted.
The work of surveillance of contacts, though easy to carry out in connection with
isolated cases of smallpox, assumes formidable dimensions during an epidemic.
The number of contacts kept under observation by officers of the Public Health
Department during 1929 was probably not far short of 3,000.
As will be seen from the table on page 17, the number of cases of smallpox
increased steadilv during the year, and during the last quarter the work of contact
surveillance falling upon the Sanitary Inspectors was so great as to seriously interfere
with their usual duties.
What has just been said regarding the Sanitary Inspectors applies also to the
clerical staff. A system of close co-operation and exchange of information has
developed betwee.n public health departments dealing with smallpox and the work