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18
The following correspondence arose in connection with an outbreak of Small-pox
in the town of Gravesend:—
Town Clerk's Office,
Gravesend.
15th July, 1919.
INFECTIOUS DISEASE.
Dear Sir,
I am directed by the Health Committee of the Gravesend Town Council to write to you with
reference to the recent outbreak of Small-pox.
The Committee are of opinion that there is strong prima facie evidence that the outbreak
is due to the proximity of the Denton Hospital to the town. Out of the 18 cases that have
occurred all except one came from a district which is near the Hospital. The Committee are
of opinion that the Hospital is too near a large population, and that the treatment of infectious
disease, especially a disease like Small-pox, should be discontinued. They suggest that arrangements
might be made by which infectious disease should be dealt with in the hospital in Long
Reach, and that the Denton Hospital could be used for non-infectious cases.
The Committee are also of opinion that some arrangements ought to be made by which
the Borough could be relieved of the expenses of dealing with Small-pox cases which arise largely
from ships coming to the Port. They think it unfair that a small town should have to bear the
whole of this cost, and suggest that the Port Authority ought at least to make a contribution.
I am,
Yours truly,
(Signed) H. H. BROWN,
Town Clerk.
The Clerk, Port Sanitary Authority.
Guildhall,
London, E.C. 2.
1st October, 1919.
Dear Sir,
The Committee of the Port of London Sanitary Authority, having considered your letter
of the 15th July last, have directed me to reply to you as follows :
The 18 cases which have occurred in the district situated near Denton Hospital do not
constitute any evidence that the Hospital is a menace to the town. It is clearly shown by the
dates of onset in the various cases that a group of four cases between the 23rd and 26th were
infected from a source undiscovered, and the remainder were all contact cases with these four.
Of the late cases, in two no contact with the previous cases of Small-pox was traced, but the
date of onset in one of these coincides with that of a number of other cases in the later group,
and the occupation of the other was that of a teacher at a school in the infected district; these
are to be included amongst the contact cases.
We have, therefore, to deal with a group of four early cases infected from a common source,
not with 18 cases constituting "strong prima facie evidence" as having occurred in a district
near the Hospital. These first four cases, as indicated by their dates of onset, are referable to
one unknown source, and, as in almost all Small-pox epidemics, to one case which apparently,
up to the present, has not been traced. This common source was at large early in May. Cases
were admitted to Denton Hospital on the 23rd April, and one case on the 2nd May, so that
the period of infection coincides with the presence of cases in Denton Hospital, but this fact
constitutes the only link in the way of evidence that there is any possible connection between
the outbreak and the Hospital.
The Port of London Sanitary Committee would point out for your information that there
were at that time many possible avenues of infection : the Croydon outbreak, for instance, was
traced to its one source—a soldier. It must also be remembered that the Gravesend Military
Barracks are situated as close to the four early cases at Gravesend as is Denton Hospital—one
of the cases, indeed, practically in the same street with the Barrack gates—and the possibility
of outbreak arising from military dispersal on demobilisation was at that time a matter of
anxiety to every Sanitary Authority.
Secondly, about that time there was a serious menace to all South and East Coast Ports
by reason of the large infected areas both on the Continent and in Asia. Sailors from every
port in the Kingdom come to Gravesend in search of, or taking up. employment, and form a
possible source of just such a mild case as is a common precursor of a,n epidemic.
Further, many boats enter the river or lie at Gravesend which have come from infected
ports, their voyage having occupied less time than the incubation period of the disease. A case
arising after the arrival of such a vessel, and after the crew has been paid off, is a third possible
source of infection.
The known and guarded cases are not the usual sources of epidemics, but unknown mild
ambulatory cases.