THE EPIDEMIC OF SMALLPOX

_______________________

 (FROM OUR SHEFFIELD CORRESPONDENT)

Yorkshire and, indeed, a great portion of the North of England seem likely to be involved in the epidemic of smallpox that is now running its course in Sheffield and the neighbourhood.  Isolation, unfortunately, has failed in Sheffield , or rather the disease spread so rapidly that sufficient means of isolation could not be provided in time.  The result was that the outbreak spread into every quarter of the town; and so far from the disease having abated, the number of fresh cases has increased month by month until, during December, over 800 additional cases were reported to the authorities.  The disease has now existed in Sheffield nearly nine months. On the 24^th of March three cases were reported from the district of Nether Hallam, not far from the barracks.  Although occurring in different houses the patients were near relatives and had each come in contact with another relative who was said to have had "spots on the skin."  These cases gave rise to four other cases in the immediate neighbourhood, all being removed to the borough hospital, which is situated in a thickly inhabited portion of the town.  During April smallpox appeared among the clerks in a large works at Brightside, and the medical officer of health, after a searching inquiry, inclines to the belief that the outbreak was due to fresh importation of the disease into the town.  Several of the clerks had the disease in a mild form and, unfortunately, these cases were not recognized to be smallpox until late in the disease, and not until after they had infected several other persons.  The disease began to assume alarming proportions about the middle of July.  Towards the end of that month the cases became so numerous that the hospital had to be cleared of scarlet fever patients, and it has been since used exclusively for persons suffering from smallpox, while the number of beds available for patients has been increased from 64 to 84.  In August the hospital committee of the corporation, who still had hopes of checking the spread of the disease, secured temporary hospital accommodation at Totley, four miles from the town, and just over the Derbyshire boundary.  The inhabitants were scared, and issued a writ against the corporation for an injunction, which, after four weeks' delay, was dismissed.  Unhappily this delay proved very serious, for the disease spread, and many patients were obliged to be treated at their own homes.  Even when there was a constant circulation of convalescent patients from the borough hospital to Totley the accommodation was by no means sufficient to enable the authorities to cope with the serious character of the epidemic.  In fact, at this time the epidemic had got beyond the power of the hospital committee, and all hope of isolation had gone.  This will be shown by the following figures.  Up to the 8^th of October 668 cases were reported to the medical officer, 291 of which occurred previous to August 27 and 377 since that date.  Of the 291 cases, 229 were admitted to hospital, while of the 377 there was only accommodation for 110.  Soon after the establishment of the hospital at Totley the Corporation acquired an estate at Redmires, four miles from the town, with the view of constructing premises of a permanent character. Contracts have been let, and accommodation for 60 patients will be ready by the 15^th inst.  There will then be 204 beds available for smallpox patients, apart from the hospitals in connexion with the two workhouses.  The spread of the disease is shown by the following figures:-  In March there were 3 cases, 4 in April, 21 in May, 43 in June,, 91 in July, 146 in August, 275 in September, 498 in October, 604 in November, and 800 in December.  Up to November 21, out of a total of something like 1,550 cases, only 581 were treated in hospital.  The epidemic has increased the death-rate in Sheffield , but not to a very exceptional extent.  For the week ending November 19 smallpox caused 25 deaths; November 26, 16 deaths; December 17, 17 deaths; December 24, 21 deaths.  For the last five weeks the death-rate from all causes in Sheffield corresponded to the following rate:-  December 3, 29.2; December 10, 23.8; December 17, 29.2 December 24, 23.9; December 31, 27.  One notable circumstance in connexion with the epidemic has been a system of workmen's insurance that has been adopted in nearly every manufactory in the town.  Every workman agrees to pay so much to a general fund, the proceeds going to pay any one who is either smitten with the disease or prevented from working through having smallpox in his house.  This system has worked well and saved a great amount of distress, besides doing much to secure isolation.

Sheffield is credited with having spread the disease into the towns and villages surrounding it and no doubt many of the outbreaks that have occurred can be traced to Sheffield , but not all.  At Leeds there are not 39 cases of smallpox in the hospital of which 12 are convalescent, and at Bradford a case has occurred, and there is some fear lest the disease may have obtained a foothold in the town.  At Lincoln there have been three cases, but the city is now free from the complaint.  At Rotherham, which is only six miles from Sheffield, the disease is practically stamped out, five out of the six cases being convalescent.  In Rotherham there is power to enforce compulsory notification - a provision which is lacking in Sheffield .  Some of the villages near Sheffield have suffered severely, such as Rawmarsh, Wath and Swinton.  In every direction local authorities are establishing infectious hospitals with the view of stamping out the dreaded disease.  During the course of the epidemic it has been pretty well proved that vaccination in infancy is an almost complete preventive of smallpox during the first 12 to 15 years of life, and that a second vaccination is a perfect preventive during the remainder of life

                   _______________________