Report on an outbreak of mild smallpox in New South Wales in 1913, and the measures taken for its control / by W.G. Armstrong, J. Burton Cleland and E.W. Ferguson.

  • New South Wales. Department of Public Health.
Date:
[1914]
Catalogue details

Licence: In copyright

Credit: Report on an outbreak of mild smallpox in New South Wales in 1913, and the measures taken for its control / by W.G. Armstrong, J. Burton Cleland and E.W. Ferguson. 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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    suffered rather closely resembled those which occurred among the Chalmers-street girls. Some weeks later however it was discovered that R.G. had been on friendly terms with one of the affected girls in the lastnamed factory, and had probably been in her company about three weeks before she was herself attacked by the eruption. Subsequently also R.G. when vaccinated did not react to the vaccine though she had never before been vaccinated, and two other persons vaccinated at the same time from the same tube of lymph developed the usual vaccine lesion. On 18th June the Sydney Hospital authorities notified the Department that a very unusual form of eruption had occurred in a patient in that institution. The hospital was visited by a medical officer of the Deoartment and the patient E.B. was seen there. She was covered with a copious rash which in its appearance and dis- tribution showed many resemblances to smallpox. The patient was sent the next day to the Coast Hospital, and as a measure of precaution all the persons in the ward of the Sydney Hospital were vaccinated. This case was considered to be very suspicious of smallpox in spite of the fact that the patient, who «as unvaccinated, showed very little constitutional disturbance. Doubt was also cast upon the accuracy of the diagnosis in the earlier cases. Tn order to obtain more conclusive evidence, six of the persons who had been effected by the illness at first believed to be chicken pix were persuaded on 18th and 19th of June to allow themselves to be vaccinated under control conditions; that is to say the patient and one or two other persons who had not been affected by the illness were in each case vaccinated from the same tube of lymph. By tbe evening of Monday, 23rd June, it had become apparent that in every instance the person who had suffered from the attack or supposed chicken pox had failed to respond to the vaccination, though all the “ controls ” showed signs of successful vaccination. Neither the “ controls ” nor the “ patients ” had ever previously been vaccinated. On 24th June the Honorable the Premier was informed of the position, and of the strong suspicions which had arisen that smallpox was present in Sydney. Authority was obtained from him to seek the opinion and advice of two medical practitioners outside the Department, and Dr. Charles Reid, Chief Quarantine Officer for New South Wales, and Dr. Walter Hull, were invited and consented to examine the patients who were known to be suffering or to have suffered from the suspicious illness. After visiting the Coast Hospitals and the private homes of the patients these gentlemen reported on the result of their inquiry to a special meeting of the Board of Health on 25th June. On hearing the opinions of its own officers and of the two expert practitioners abovementioned, the Board decided that while the symptoms in some of the cases were suspicious of smallpox, eveiy precaution—such as isolation, Ac.—should be used until further vaccination results could be obtained. This further evidence was accordingly sought for and on Tuesday, 1st July, the Department’s officers submitted to the Boa-d of Health further evidence that seven persons who had suffixed from the suspicious disease did not react to vaccination, while control vaccinations weie successful in each case The disease was accordingly proclaimed by the Board on that date to be smallpox. Nature of the Disease. The evidence as to the identity of the New South Wales epidemic with true smallpox may be briefly summarised as follows :—The symptomatology is essentially the same, only differing in intensity of the manifestations. The period of incubation was the same. Vaccination was found to protect against the Sydney disease and an attack of the disorder was protective on the other hand against vaccination. ’Hie liability to abortion among pregnant women and the infection of the fcetus, which are so characteristic of classical smallpox, were also observed in the epidemic in Sydney. The more severe cases were accompanied by the typical variolous odour and followed by the depressed scarring or pitting of the skin which is the usual sequela of classical smallpox. So far as one can speak at this present time, the pitting promises to be permanent. All these characteristics except the lastnamed were entirely absent in the numerous cases of chicken pox which were under observation in Sydney during the smallpox epidemic. Chicken pox was unusually prevalent and unusually severe in Sydney during the year 1913. Over 3,000 cases of chicken pox were seen and diagnosed by the staff of the Health Department during the epidemic of smallpox, and with very few exceptions the experienced staff found no difficulty in differentiating between the two diseases. Many instances occurred of chicken pox among recently vaccinated persons, and on the other hand in many cases persons recovering or but lately recovered from chicken pox were successfully vaccinated during the months of the epidemic. These observations were in marked contrast to the facts in relation to the cases of smallpox. The theory that the disease observed in Sydney was a hybrid, is unscientific, and will not bear examination fora moment. The behaviour of the two diseases towards vaccination entirely negatives any such supposition. Smallpox, like all other diseases, has varied in intensity in different outbreaks. Mild outbreaks have been observed from very early time. Sydenham states that “smallpox has its p-culiar kinds which take one form during one series of years, and another during another.” Jenner himself records an outbreak in which the virulence was surprisingly low. He says “ it was of so mild a nature that a fatal instance was hardly ever heard of, and consequently so little dreaded by the lower orders, that they scrupled not to hold the same intercourse with each other as if no infectious disease had been present among them,” and Van Swieten, in 1759, describes an outbreak which was “so mild that secondary fever is not manifested, and constantly is wanting, convalescence coming on on the eighth day of the eruption To