View report page

10
Small-pox visited the Borough during 1928, as during the
previous year, and my report to the Committee on the case, omitting
the addresses given in my report, may be of interest as showing the
routine procedure for dealing with this disease, and the likelihood of
further cases occurring in London :—
23rd June, 1928.
On the 18th instant 1 visited a case residing at-who was reported to have a suspicious
rash, and sent the patient, who was suffering from Small-pox, into hospital. The family were
removed to the Isolation Shelter and the Office at the patient's home was removed to another
address, disinfection of the entire premises being carried out that night. The history of the
case was obtained and vaccination was offered to all Hackney contacts and accepted by 32
contacts. Stripping of the walls of the bedroom and spraying and cleansing were carried out
on the following day.
The movements of the patient were traced from June 2nd, up to the time of his removal,
and the Authorities concerned notified so that any missed case could be discovered and contacts
kept under supervision.
The patient fell ill on the 11th and the characteristic rash appeared on the 14th, and it is
probably only from the latter date that the patient himself can have infected others, but even
from that short space of time it results that 47 contacts must be kept under observation in
Hackney and 71 contacts in other Boroughs to whom the information was immediately forwarded
from Hackney. Contacts to Small-pox cases must be visited daily and examined on falling ill,
and since there is generally a period at least of 48 hours between the onset and appearance of
the rash when the case becomes infectious, by isolation and prompt removal to hospital the
circle of contacts can be kept from growing and becoming unmanageable; but if the number of
cases be too large, or contacts escape supervision, the possibility of an epidemic arises unless all
persons in contact have been recently vaccinated or are successfully vaccinated within 3 days
from exposure to infection.
Vaccination develops the protective substances in the system at a quicker rate than the
Small-pox poison develops, so that vaccination has a three-days' start of Small-pox so to speak,
so that in the case of the wife and children of the patient who were exposed to infection since
the 14th, if infection was contracted on the 14th, the vaccination is too late to protect, but if,
for example, the infection was contracted on the 18th when I saw the patient, the vaccination
will absolutely protect. Vaccination too late to prevent development may modify the course of
the disease. But in any case, since the family is visited daily and will be examined and removed
on the first definite sign of Small-pox, if this should unfortunately develop, opportunity for spread
should not arise.
The usual arrangements for visiting and supervision of all contacts are in full working order,
and the improved arrangements recently adopted by the Committee for carrying out disinfection
will be of value should any further cases develop. The County Council and the Ministry of
Health, the Guardians and all Authorities concerned were notified immediately I had removed
the case. All contacts are at present in good health, but until July 2nd at the earliest I cannot
state that contacts may not develop the disease. The critical period will be from June 26th
to July 2nd.
The origin of the infection of this case has not been discovered, but I wish to draw the
attention of the Committee, in this report, to what has been happening in London. In my
opinion, control of the disease must be considered to be definitely weakened, and as a result
new cases are cropping up in the manner in which they are now doing. In the majority of
instances the attacks arc mild, but some have been severe, and the mild attacks may cause
severe attacks in other people, as of course occurs in all diseases as, for instance, Scarlet Fever
and Diphtheria. In South London, children have been found in school with the characteristic
rash ; and in this connection there are two facts to be borne in mind : firstly, that with a mild rash
the symptoms may be mild, the constitutional signs in Small-pox usually being in ratio to the
amount of the eruption, and secondly that there is a period, after the appearance of the rash,
when the patient feels at his best, and the temperature may fall to normal even in a very severe
case. Following this period, as the changes which produce pus or "matter " in a rash occur,
the constitutional symptoms return.
Most of the cases that have occurred in London have been of a mild type, but not all ; in fact
some have been severe. In my opinion in view of the particulars I am placing before the Com
mittee, the position as regards Small-pox in London during the coming winter will be very
critical. The number of cases that have occurred during this favourable time of year, together
with the obvious fact that once the number of cases becomes too large control must break down ;
also seeing the likelihood of missed cases, as shown for instance by the discovery of children in
school suffering from Small-pox, and the fact that infection seems to be breaking out where the
connection with previous cases is of the vaguest nature, render the outlook most unfavourable.
As regards the Hackney case, it is obvious that there is at all events a strong probability that