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10
During the past two years I have made no secret of my views
that there was a likelihood of a smallpox epidemic in London. I have
referred to this fact in my Annual Reports for the years 1927 and
1928, and I have also so reported to the Public Health Committee on
several occasions. In a letter dated 6th May, 1929, addressed to the
Minister of Health at the request of the Public Health Committee,
dealing with the opposition to vaccination, the Ministry were informed
as follows—
"The Public Health Committee of the Borough Council has had under
consideration a report of the Medical Officer of Health with regard to smallpox
contacts, from which it appears that over 200 contacts living at different
addresses are under observation in Hackney, and this in spite of the fact
that an actual case of smallpox has not this year occurred in the Borough.
The Medical Officer of Health also stated that in his opinion smallpox is
out of control in and around the London area, and that it is futile to expect
Memo. 71A (Med.) of the Ministry of Health to be carried out in any
Borough where cases occur from unknown sources of infection, and in addition
from two to three hundred households require visiting as a routine
measure, unless, of course, the other work of the Department is to be put
on one side. The Medical Officer of Health stated that the neglect of
vaccination is now so widespread, and vaccination is so generally refused,
even by smallpox contacts, that it is impossible to expect adequate supervision
from his Department should the state of affairs mentioned above,
which has happened in many Boroughs, also occur in Hackney."
The situation as regards smallpox in London is from one aspect
ludicrous, from the other tragic. Contacts must not be excluded from
work; they cannot be made to undergo vaccination. Public Health
Departments are continually shutting the stable door after the horse
is stolen. The Ministry of Health rigidly insist in Memo. 71A (Med.)
that contacts should be visited for sixteen days, and that when one of
these contacts, who has been permitted to run about during the usual
twelve days of incubation, has contracted the disease, enquiries should
be made into his movements during the three weeks preceding the
commencement of his attack, and the following up of all the additional
contacts made as the result of becoming a patient.
The Metropolitan Branch of the Society of Medical Officers of
Health have suggested reasonable modifications of Memo. 71A.
(Med.) which would in no way weaken control, such as it is, but without
result. The dilemma is obvious. The Memorandum, workable so
long as the number of cases only amounted to half a dozen in the year,
becomes ludicrous when from six to twelve cases are being notified
daily over a period of months, yet to modify the Memorandum might
lead to charges of treating the outbreak lightly.
The Ministry, having issued Circular 1025 on 19th August, 1929,
with regard to vaccination—obviously calculated to dissuade persons
from being vaccinated unless they happen to know the true facts about
the encephalitis cases which have occurred during the last few years
these cases being the ostensible reason for the Circular—followed up