Dr. R. Bruce Low's report to the Local Government Board on the arrangements made in Germany for the isolation of small-pox cases.

  • Low, Robert Bruce, 1846-1922.
Date:
1904
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Licence: In copyright

Credit: Dr. R. Bruce Low's report to the Local Government Board on the arrangements made in Germany for the isolation of small-pox cases. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    2 The notification of small-pox is obligatory throughout the German Empire, and the persons required to notify the disease to the police authorities are : (1) * the attending medical practitioner, (2) the head of the household, (3) any person who has attended on or nursed the patient, (4) the person in whose dwelling or lodging the case or death has occurred, and (5) the Coroner. 11 Those named in (2) to (5) are only bound to give notice if the first-named is not at hand. As soon as the police authorities of the district have received notification of the occurrence of small-pox, the information is at once communi- cated to the Medical Officer of Health, whose duty it is to examine immediately into the circumstances of the case, and to make a report thereon. All persons suffering from small-pox, or suspected to be suffering from small-pox, can be ordered to hospital for isolation if, in the opinion of the medical adviser of the local authority, the patient cannot be properly isolated at his home. In particular cases where the condition of the sick person is so grave as to make, in the view of his medical attendant, his removal to hospital dangerous to life, he may be allowed to remain at home. I was informed also that in rural districts remote from any hospital the patient might also, with the consent of the Medical Officer of Health, be permitted to remain at home during his illness. On the occurrence of a case of small-pox in a house, the contacts are immediately vaccinated or re-vaccinated. In some towns the contacts are removed to a place of isolation till the danger of their developing small-pox has passed. In Germany separate small-pox hospitals are not provided, except in rare instances. Cases of this disease rale, removed to the general hospital of the town or district, where commonly a pavilion is kept always in readiness. Not unfrequently it is thought enough to clear out the patients from some occupied pavilion and transfer them elsewhere, so as to make room for the small- pox case or cases. In a very few instances, as for example at Frankfort-on-Main, the portion of the general hospital site on which the small-pox pavilion stands is fenced by a stone or brick wall, to prevent communication between the other parts of the hospital and that on which small-pox cases are isolated. This pavilion is, in the absence of small-pox, commonly used for the treatment of other maladies, infectious or otherwise, as required.1 Occasionally, as at Dresden, arrangements are made to erect a temporary wooden fence round the small-pox pavilion as soon as a case is admitted. But generally, as has been said, small- pox cases are isolated in a pavilion standing on the site of the general hospital, and in no way shut off from the rest of the establishment. In most cases this pavilion is supplied with food from the central kitchen, and the soiled linen of small-pox patients is sent to the general laundry after being steeped in some dis- infecting solution. The nurses and the medical officer or any other persons whose business brings them into relation with the small-pox pavilion are at once re-vaccinated as a matter of routine ; but re-vaccination of the whole hospital personnel is not carried out, reliance being placed on the statutory vaccination and re-vaccination of the general population under the German Vaccination Law of April 8th, 1874.* Making inquiry as to whether small-pox had been observed to spread from the isolation pavilion to the rest of the general hospital or to houses in the immediate neighbourhood, I was informed by Dr. Wutzdorff (Geheimer Regierungsrat und Director im Kaiserlichen Gesundheitsamt) that instances of such spread were very rare, and that when they did occur the persons infected were those whose primary vaccination had not for one or another reason been carried out, or whose re-vaccination had been performed at a comparatively distant period. Dr. Wutzdorff also told me that occasionally small-pox cases, not diagnosed at first as such, had been admitted to wards or pavilions in a general hospital and had spread the infection to unprotected persons coming into relation with them. At Berlin several instances of this kind had recurred both at the Charite and at the Friedrichshain hospitals during the la«t few years, as will presently be seen. In the opinion of Dr. Wutzdorff * Young children must be vaccinated before the end of the calendar year following the year of birth ; and all school children must be re-vaccinated in their twelfth year. Obedience to this law is enforced by fine or imprisorment.