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58
who was thought to be suffering from chickenpox. by the time the
diagnosis was changed to smallpox the passengers had dispersed and no
particulars of where they had gone to had been kept. A broadcast appeal
was made and in this district the doctors were written to telling them
of the position.
Against the risks of any particular person contracting infection in
these circumstances, there is only one protection—vaccination, with
re-vaccination if the individual is to be subject to special risk. The
position as to the vaccination of the population is anything but satisfactory.
In this district last year, 1,788 persons were vaccinated for
the first time, but only 895 were under one year of age and only 1,229
were under two years of age, and 812 re-vaccinated. In the same year,
2,895 babies were born. These figures, poor as they are, are possibly
better than those for the country as a whole. It must mean much hard
work before the position can be made satisfactory. Even before 1918,
as many parents took advantage of the powers available to them to
avoid having their children vaccinated as had them done. The mere
fact, too, that the compulsory element of the laws about vaccination
was removed by the National Health Service Act, must have led many
quite genuinely to assume that there was not much to be said for the
practice. Another factor of importance which is likely to lead to fewer
vaccinations being done is that there are now no officers, corresponding
to the Public Vaccinators and the Vaccination Officers, charged with a
duty to see that babies are vaccinated. On top of that, is the confusion,
because of the different views expressed, about the place of mass vaccination
of the general public in the face of an outbreak. At such a time
the public is not only willing, but demands to be vaccinated, even though
so many of them will not have been contacts of infected persons or of
infected articles and therefore they are not really subjects of risk. But
because they feel that they possibly may have been exposed, they clamour
to be vaccinated, to the great difficulty of those who have to deal with
those who have been infected and with their immediate contacts who
definitely are at risk. An individual can be protected against the risks
of contracting smallpox by being vaccinated or re-vaccinated. An outbreak
of smallpox can be limited by the vaccination of the immediate
contacts of patients, if it is possible to do this early enough; if it is not
and the disease develops in some of the immediate contacts, then by the
early vaccination of their immediate contacts (and this is something
which can usually be done in time) spread is restricted. These are the
measures which the authorities carry out to prevent the spread of smallpox.
Authorities should not at such times be burdened with the demands
by the masses for their vaccination, more especially of those who would
not need to be anxious if they had only taken advantage at the ordinary
times of the facilities available for them and their children to be vaccinated.
ENTERIC FEVER
Of the 13 patients notified to be suffering from enteric infection,
the diagnosis was altered to some other condition in six. The first
of the cases in which the diagnosis was confirmed was a man who was
removed to hospital the day he came to this district from another part