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certified to be suffering from small-pox were removed in 1891,
but in only 04 of these cases was the diagnosis confirmed bv
the medical superintendents of the hospitals to which the
patients were removed. One of the remaining cases was
removed to a fever hospital ; the others were returned to
their own homes at once. " Of the 63 patients admitted, three
appear to have been infected outside the United Kingdom,
and several others were probably infected while working at
the docks ; one of these gave rise to nine other cases. In 21
cases no source of infection could be ascertained." The disease
showed itself in 20 different localities : most of the cases came
from the neighbourhood of the docks, and 43 occurred within
a space of less than six weeks, viz., between the 13th of April
and the 23rd of May. The Managers took occasion from
these occurrences to call the attention of the Local Government
Hoard to the need for measures for securing prompt
disinfection and re-vaccination after the first appearance of
small-pox in any house. " The prompt removal and isolation
of infected persons which is the duty entrusted to the
Managers, is only one of several measures necessary to be
adopted " for checking the spread of small-pox. Defects in
the machinery for this purpose, which is "shared by 41
distinct authorities, have become apparent to the Managers
in the execution of their own work." Instances have occurred
in which they had been the first to report infectious cases to
the Sanitary Authority, who have the control of the disinfecting
arrangements, but no control over those for vaccination.
This is in the hands of the vaccination officer, who is
responsible to the Guardians of the Poor; whilst for the
vaccination or re-vaccination of adults no compulsory powers
exist. The Committee observe with reference to this state of
things, that "if the Managers, in addition to being the hospital
authority were also, in relation to small-pox, constituted a
Sanitary Authority, with power to direct measures of disinfection;
and also, if the legislature should think fit, vaccination
or re-vaccination, they would be in a position to carry
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