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10
Small-pox visited the Borough during 1927, and a brief note on the
cases and the routine procedure adopted for dealing with small-pox is
of interest at the present time when cases are occurring throughout
London. The usual procedure is as follows:—
1. Vaccination is immediately arranged for contacts, and persons in, the neighbourhood.
To be effective vaccination must be performed within three days of exposure to infection.
Fortunately small-pox is not infective until the appearance of the characteristic rash.
2. Disinfection of the premises and of all premises recently visited by the patient is
carried out, all possibly infected material such as laundry, is followed up and precaution
taken against spread by these means.
3. Medical Officers of the districts of the home address of the contacts living outside the
Borough are informed.
4. Contact School children are excluded from school during the incubation period.
5. Enquiry is made af the works or other business premises of the case to obtain histories
of any other cases occurring that might have a bearing on the diagnosis, and these premises
are visited daily for sixteen days. Absences from illness are investigated.
6. General practitioners are informed of the presence of Small-pox in the Borough.
7. The Poor Law Authorities are informed.
8. The Central Authorities are informed.
9. The home! address of contacts are visited for 16 days, and cases of illness are investigated.
Case No. 1. C.R.—This man's home address was in Poplar, but the surgery of his doctor was
in Hackney, and on the 7th, 9th and 10th May, 1927, he visited the surgery. He was removed to
hospital from the surgery on the 10th May, 1927. He was an unvaccinated person. All premises
visited by the patient were kept under observation, including his workshop; the usual steps were
taken as regards the laundry and other sources of infection.
Forty contacts were discovered in Hackney, of whom 22 had visited the surgery. Vaccination
was arranged for as regards these persons, and they were kept under observation during the usual
16 days' period. It was evident that there was considerable danger of the spread of the disease,
and I took Mr. Nighy, the Sanitary Inspector for No. 10 District, from his district after making
the necessary rearrangements for his district work, in order to have assistance over the whole
Borough as regards Small-pox. The patient in this case recovered and was discharged.
Case No. 2. A.T., aged 4.—This child, who had never been vaccinated, was removed to
hospital from the Eastern Hospital, on the 17th May, and died on the 23rd May, 1927. There
were only three contacts resident in Hackney.
Case No. 3. C.S.—-This was a contact case to No. 1 (C.R.), who had, unfortunately, owing
to his absence from home, escaped vaccination at the same time as the others. He was kept
under daily observation and was removed to hospital on the 19th May, 1927, at the first onset of
his illness. The other member of his family had been protected by vaccination. He recovered
and was discharged.
Cases Nos. 4 and S were removed from the Eastern Hospital and the Metropolitan Hospital
respectively, and the diagnosis made at those institutions wa9 not confirmed. Each case was seen
by a Small-pox specialist before removal.
As regards the case removed from the Metropolitan Hospital, 68 contacts were resident in
Hackney and 83 in other Boroughs. The alteration in diagnosis permitted cessation of visiting of
contacts in 5 days.
Case No. 6. P.R. was a tramp sent into hospital on the 14th June, 1927. He had been
vaccinated in infancy and was suffering from the modified type of Small-pox which has been
prevalent in the Midlands. He had called at various casual wards on his journey down from
Barnsley, which he left on the 11th May, 1927, to Hackney, where he was admitted on the 13th
June, 1927, at 9.45 p.m. On the morning of June 14th, when I saw the case with Dr. Sturdee,
of the Ministry of Health, the rash had probably been out for several days. The Medical Officers
of all the districts concerned, 14 in all, were informed on the same day. Endeavours were made
successfully, to trace the casuals who had been discharged before I saw the case, and 11 of them
were brought back to Gainsborough Road. One casual, who had jumped the wall in the night,
and a casual who had enlisted in the Army, were also traced. Vaccination of staff and casuals
was carried out in the usual way, with the exception of two casuals who refused to be vaccinated.