991

in north and mid-England, the following infoimationis of interest:-

TABLE II.

4038 Cases of Small-pox (Vaccinated)-28 under 15 years...... no deaths.

392 " 15-30 years.... 1 death.3618 over 30 years...... 3 deaths. *

* Two over 70 years.

17,718 Cases of Small-pox (U’yi.MMCMtaM)—10,709 under 15 yearc .... 17 deaths..5,296 " 15-30 years.... 1 death.1,713 over 30 years...... 2 deaths. *

* One over 70 years.

At the present time there are two distinct and.different types, one of a high degree of virulence andusually impoited from the East and Africa; the.other of extreme mildness which may have come tous from the United States where this type of diseasehas been present for many years. Even in theUnited States there have been from time to time.outbreaks of the more severe form, presumably dueto importation from outside of a more virulentstrain. In the Detroit outbreak of 1924, for instance,there was a total of 795 cases and 105 deaths.The Merseyside area has been free from small-

pox in epidemic form for some considerable time,and it may be opportune to record the few cases of,apparently virulent type which have recently,developed in this area and have been treated at theNew Ferry isolation hospital.’The first case was that of a cotton-sampler who

fell ill about the beginning of July, 1930, but was’not recognised to be suffering from small-pox;five is stated to have attended a doctor for influenza.This patient did not go to work after the first day ofhis illness, and for at least three weeks subsequently.’The rash was scattered over body, hands, and face,and when seen, the remains of the staining wereevident. This patient infected his wife and two otherpersons, one of whom died from haemorrhagic andtoxic small-pox. After an interval of about twomonths another group of four cases developed in theneighbouring borough with one very severe confluent<case (unvaccinated) amongst them.The present outbreak in Merseyside seems to be of

the virulent type. The patient C. died three daysfrom the appearance of the eruption. The vaccinationarea was faint and small, and as a result his vulnera-bility was high. The case was of the haemorrhagicand toxic type. Case H. (unvaccinated) was of theconfluent type, the whole body from head to footbeing a mass of eruption, which after a few dayspustulated; when secondary fever occurred thepatient’s life was in jeopardy, but fortunately carefulnursing and treatment brought about his recovery.He was also of an age when the fatality is low. Thee’two groups of cases of small-pox occurred within ashort time of one another in the two adjacent andthickly populated areas, and seem to point to thefact that the later cases in Birkenhead were derivedfrom those in Wallasey by the intermediary of someunrecognised case.The methods adopted by the medical officers of

’health -were as follows-viz., prompt vaccination.and revaccination of contacts (who may not in many.cases be easily ascertained), the supervision of thesefor the usual period, personal examination of contactsby the medical officer, together with house-to-housevisitation. As in times past, these have had theeffect of bringing the disease under control. Theextensive maritime trade of this country rendersit very liable to importations of the virulent form ofsmall-pox and the necessary facilities for dealing withthem should be in constant readiness. The risks ofimportation are increased by the rapid passage ofvessels from port to port and the long incubationperiod of the disease. No system of port sanitaryadministration, however efficient, can prevent the"possibility of such importations taking place.

HOSPITAL ACCOMMODATION FOR

INFECTIOUS DISEASE.THE Minister of Health has instructed county

councils (other than London) to survey the hospitalaccommodation available in their counties for thetreatment of infectious disease. In an accompanyingmemorandum it is stated that experience has shownthat a large hospital serving a wide area forms a moresatisfactory administrative unit than a number ofsmaller hospitals serving smaller areas, and withmodern means of transport the removal of patientsto a hospital situated at some distance from theirhomes presents little difficulty. It is suggested,therefore, that each county council should considerwhether it would be desirable to close any smallhospitals which are found not to be satisfactory, andto enlarge those hospitals which are satisfactory in allrespects and can conveniently be extended and madeto serve a wider area.

" It is particularly desirable," says the memorandum,that, in the course of their survey, the county councilshould explore the possibility of further cooperation withthe councils of county boroughs. In some cases it may befound that the additional accommodation required for somepart of the county could most economically be provided bythe enlargement of an existing hospital belonging to a countyborough council, and it is, therefore, suggested that, wheresuch conditions appear to exist, the county council should... consult with the council of the county borough as to thepossibility of such an enlargement being undertaken and asto the terms on which the new accommodation could bemade available for the inhabitants of the county."When the survey has been. completed, the countymedical officer is to make a report to the council witha view to the preparation of a scheme. The reportshould review the existing accommodation andarrangements as disclosed in the survey, and makerecommendations as to which hospitals shouldcontinue to be used with or without enlargement oralteration, what additional hospitals are required, andwhat (if any) alterations should be made in the areasserved by existing hospitals. In this connexion theMinister calls attention to the growing need for theprovision of hospital treatment for complicated cases- of measles, influenza, pneumonia, whooping-cough,and the acute infectious diseases of the central nervoussystem.

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INFECTIOUS DISEASEIN ENGLAND AND WALES DURING THE WEEK ENDED

OCTOBER 18TH, 1930.Notifications.-The following cases of infectious

disease were notified during the week :-Small-pox,125 (last week 44) ; scarlet fever, 2290 ; diphtheria,1568 ; enteric fever, 50 ; pneumonia, 728 ; puerperalfever, 42 ; puerperal pyrexia, 123 ; cerebro-spinalfever, 11 ; acute poliomyelitis, 21 ; acute polio-encephalitis, 6 ; encephalitis lethargica, 8 ; continuedfever, 1 ; dysentery, 16 ; ophthalmia neonatorum,106. No case of cholera, plague or typhus fever wasnotified during the week.The large number of small-pox cases reported this week

more than counterbalance the small number of last week.Of the total of 125, 33 were reported from the county ofLondon and the remainder from the following 9 counties :Durham, 3 (Jarrow) ; Essex, 42 (of these West Ham 23,Barking Town 13) ; Kent, 1 (Margate) ; Lancaster, 3 ;Leicester, 27 (C.B. 19, Blaby R.D. 7) ; Lincoln (Lindsey)10 (Caistor R.D.) ; Middlesex, 1 (Hendon) ; Yorks (WestRiding), 4 ; Monmouth, 1.The number of cases in the Infectious Hospitals of the

London County Council on Oct. 21st-22nd was as

follows : Small-pox, 154 under treatment, 3 under observa-tion (last week 140 and 4 respectively) ; scarlet fever, 1708 ;diphtheria, 2066 ; enteric fever, 23 ; measles, 95 ; whooping-cough, 112 ; puerperal fever, 17 (plus 5 babies) ; encephalitislethargica, 121 ; " other diseases," 38. At St. Margaret’sHospital there were 12 babies (plus 2 mothers) with ophthal-mia neonatorum.Deaths.-In the aggregate of great towns including

London there was no death from small-pox, 1 (0) fromenteric fever, 6 (0) from measles, 2 (0) from scarlet