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The Order was made as a result of a communication from the Ministry of
Health requesting the Council of any Metropolitan Borough in which chicken-pox
is not notifiable to take the matter into immediate consideration if small-pox
occurs in the Borough or in any adjacent area. It was further suggested that
suitable arrangements should be made for visiting all such cases with a view to
confirming the diagnosis.
562 notifications have been received to date under the Order, and I have made
377 visits to unvaccinated patients stated to be suffering from chicken-pox for the
purpose of verifying the diagnosis. In 18 cases the patient was found to be
suffering from small-pox and not chicken-pox, but in only four instances was notification
useful in drawing attention to the presence of small-pox in a household
which otherwise would have escaped detection. The remaining 14 cases would,
in all probability, have been discovered in the ordinary routine of " following
up " contacts of previously reported cases of small-pox.
It will thus be seen that the percentage of patients who were notified as
suffering from chicken-pox and found to have small-pox is extremely small.
The Order is due to expire on July 17th next, unless the Council decide to
extend its operation for a further period. In order, therefore, that your Committee
may be guided in their consideration of the matter, I propose to set out the factors
for and against the compulsory notification of chicken-pox as an effective administrative
procedure.
(1) In times of prevalence of the malignant type of small-pox, compulsory
notification of chicken-pox is of essential importance.
(2) Notification is intended to secure detention and removal of cases at
a very early stage of infectivity, and also to the discovery of cases that would
otherwise have been missed.
(3) The stimulating effect of securing medical assistance for the treatment
of any suspicious illness simulating small-pox.
The factors against compulsory notification, in my opinion, may be summarised
as follows:—
(1) The benign form of prevailing small-pox.
(2) Notifications are frequently not received in time to prevent secondary
cases occurring in the house, if the disease is found to be small-pox and not
chicken-pox, even though the contacts of the patients arrange to be vaccinated
or re-vaccinated forthwith.
(3) The small percentage of errors of diagnosis.
(4) Increased knowledge of differentiation in the two diseases.
(5) The non-necessity of notification of vaccinated children under 10
years of age.
Compulsory notification is costly and entails much time and labour, but these
considerations should have no public health significance if they provide security
to the community generally. Small-pox has now been prevalent in this borough
for such a length of time that private practitioners are constantly on the alert and
do not delay to obtain the opinion of the Medical Officer of Health on any doubtful
case.
Five months' experience of the Order has convinced me that the results are
disproportionate to the advantages expected from compulsory notification of
chicken-pox, and consequently I am of opinion, particularly in view of the present
mild character of small-pox, that a further extension of the Order is not necessary.
In the event, however, of any circumstances arising which would justify the Council
re-imposing the Order as a measure of public health importance, I will bring the
matter to the notice of your Committee forthwith.
Your obedient Servant,
H. W. BARNES, Medical Officer of Health.
The Report of the Medical Officer of Health was approved, and
the Council resolved not to re-impose at the end of the period, the