The Royal Sanitary Institute

JOURNAL op THE ROYAL SANITARY INSTITUTE REMARKS ON THE QUESTION OF THE AERIAL DISSEMINATION OF SMALLPOX INFECTION ROUND SMALLPOX HOSPITALS. By HENRY E. ARMSTRONG, D.Hy., Medical Officer of Health, Newcastle-upon-Tyne. (FELLOW.) Read at Sessional Meeting, Newcastle-upon-Tyne, March 4th, 1905. HE issue in November last by Dr. G. S. Buchanan of his Report to T the Local Government Board on smallpox in Gateshead and Felling in relation to Sheriff Hill Smallpox Hospital, has very naturally been a matter of great interest, not only to the sanitary districts immediately concerned, but tu the nation at large. For if the conclusion of Dr. Buchanan &dquo; that the use of this hospital has been responsible directly or indirectly for a material portion of the epidemic&dquo; in Gateshead and Felling be justified, and his recommendation &dquo;that Sheriff Hill Hospital shall no longer be used for the isolation of smallpox&dquo; be accepted and acted on, then every smallpox hospital placed under similar circumstances is a danger to its surrounding population~ which ought not to be permitted to exist. It is not the intention of the writer to criticise the details of a report on matters occurring outside of his own district, which he has nut But had some as to the effect personally investigated.Downloaded from rsh.sagepub.comhaving at Bobst Library, New Yorkexperience University on July 8, 2015 of smallpox hospitals on popuations living at different distances from 194 them, he ventures to offer the results of this, together with certain observations on the general question at issue. At the time of the great smallpox epidemic of 1870-72, the principal hospital in Newcastle for the reception of cases of that disease was the old Fever Hospital in Bath Lane, supplemented by a wooden block in the same curtilage, which together contained fifty-six beds. These beds, during the chief part of the epidemic, were filled with acute cases, the . convalescents being drafted to a Home at South Byker. One of the hospital blocks was only fifty feet from the densely populated dwellings of Stowell Street, and the hospital mortuary was only thirty-four feet from the same houses. The writer was medical officers of the hospital throughout the epidemic. He does not remember a single cumplaint against the hospital by the residents of the street during that period, except as regarded the smell of carbolic acid; and speaking without the hospital admission books before him, he believes that there was very little, if indeed any, smallpox among tlue inhabitants of the street throughout that period. The sectional diagram (1~. 197) shows the relative positions of tlle houses of Stowell Street and the old hospital. The two sets of buildings are sepa- rated by the old town wall, nine feet high on the hospital side, and rising to a considerable height above the eaves of the houses of the street. It may be that to this circumstance the street largely owed its immunity from infection during the epidemic. The facts were brought by the writer to the notice uf Dr. R. Thorne Thorne, then a medical inspector of the Local Government Board, on llis inquiry in 1882 into the &dquo; Use and Influence of Hospital for Infectious Disease.&dquo; An experience such as the foregoing could not well be without effect on the mind of an observer, and the lesson the writer then learnt made a deep impression. That impression still remains, but it has been somewhat modified by recent events in relation to a sharply defined group of twelve cases of smallpox at St. Petc~r’s, in the eastern end of Newezstlc.>, notified between the 27th June and tlie 16th July in last year. Ten of tliese cases occurred in one street of tenement dwellings (High Chapel Street); the remaining two cases were in closely adjoining streets. As careful inquiry failed to trace the origin of any of these twelve cases, attention was drawn to the possibility of infection having been conveyed through the air from Gateshead or Felling. The dates of firstDownloaded feeling from rsh.sagepub.comof illness at Bobstwere Library, in New each York University of the on July cases 8, 2015 compared with the directions of the wind on tllc 14th, 13the, 12th, I I th, and 10th days before 195 dates of catching of infection). Tlie arl’ t!ll’ (i.e., the’ probable folluwing’ results ,- ’ Cuses Ot Smallpox at St. Pete?>’8 ntoti fiecl f rom ’ June 97tfi to July 16th, 190i, Of the 12 cases of smallpox in question the possible infection-period occurred on days when the wind was blowing- From the south-east, in five cases (viz., on one day in each of three cases, and on two days in each of 2 cases) ; From the in one case on one south-west, day; . From the south, in six cases (fur 1 day in each case, one of these cases having also a date of possible infection on another day with a south-east wind). In one instance only was the disease likely to have been contracted when the wind was in a northerly direction on days of possible infection. The significance of the foregoing particulars will be understood when it is explained that a south-cast wind blows directly from the Felling Smallpox Hospital, and a south-by-west rvind directly from the Sheriff Hill Hospital across the river to St. Peter’s, Newcastle, where the above cases of smallpox occurred. The former huspital is a little under a mile, and the latter a little under two miles distant from the site of the outbreak of smallpox. It is not to be assumed that infection was absolutely blown across the river through the air to Newcastle, but it may Icccve úeen sc~ conveyed. There is one possible explanation of the convection of the variolous poison to a great distance which has hitherto, I believe, received little or Downloaded from rsh.sagepub.com at Bobst Library, New York University on July 8, 2015 196 no attention, and which may help to reconcile conflicting theories. Hozise- flies are a pest in smallpox wards, settling on the faces and other exposed parts of the patient when the eruption is pustular or crusting. With feet and probosces laden with the poison, they presently reach the open air, and may be carried by the wind to any distance, to infect persons, food, clothing, etc. For many years the writer has used muslin netting over the upper half of the bed to prevent the access of flies to the patient in the wards. The ventilating outlets might probably with advantage be guarded in like manner. If the cases here described, or any one of them, resulted from infection carried bv the air from one or both of the Smallpox Hospitals on the other side of the River Tyne, at what distance from such a hospital can safety be counted on ~1 In one of his reports on the spread of infection round Fulham Small- pox Hospital, the present Medical Officer of the Local Government Board, ]B1:r. li~. H. Power, records his conclusion &dquo; That the excess of smallpox in the neighbourhood of the hospital was quite and specially remarkable at a time when the total admissions to hospital had not exceeded nine.&dquo;* He subsequently stated his opinion that on one occasion there occurred a notable increase of the disease among the surrounding population when the number of acute cases in the hospital was only five. What are the practical lessons to be learnt from the foregoing? If the view be acted on that a hospital containing only five acute cases is a danger to everyone living within half a mile or a mile of it, and should be closed as such, then very few hospitals for smallpox can be left open. If those within a mile of dwellings are closed, suitable sites elsewhere will be difficult to meet with. In the event of smallpox breaking out in a district unable to provide itself with a hospital at the desired distance from dwellings, many of those dwellings would soon become more dangerous than the hospital before its closure. This raises the question, is the occurrence of a limited number of cases of smallpox round a hospital necessarily a reason for its closure ? In the past, liospitals have got the blame of spreading air-borne disease round about them, which has after- wards been traced to negligence on the part of hospital officials. Here tlie remedy is not the emptying of the wards. If infection is carried otherwise than by flies, etc., can the risk of its spread through the at- mosphere be prevented? It may at least be reduced by passing the * Fourteenth Annual Report of the L. G. B., 1884-5. Report of the Medical Otficer for 1884, p. 26. t fifteenth Annual Report of the L.G.B. Report of the Medical Officer for 1885, p. 11. Downloaded from rsh.sagepub.com at Bobst Library, New York University on July 8, 2015 197 Downloaded from rsh.sagepub.com at Bobst Library, New York University on July 8, 2015 198 Downloaded from rsh.sagepub.com at Bobst Library, New York University on July 8, 2015 199 outgoing air of the wards through fire. Apparatus for this purpose is in the market. The Sanitary Committee of the Newcastle Corporation are fully awake to the desirability of having a hospital for smallpox in some other position than the present one on the Town 112oor. But after a prolonged search no suitable and available site has, up to the present, been found.

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