CHAPTER X RECAPITULATION It is convenient to recapitulate, by way of conclusion. There are certain general considerations to be borne in mind. Instant action must be taken; personal attention must be given; there must be a well-thought-out plan; success depends on the closest attention to details, and on no detail being allowed to escape notice. A smallpox epidemic, in the nature of things, is a very expensive affair. But the expense of providing and working an effective apparatus for bringing it speedily to an end is much less than that of allowing it to drag on. It is necessary to mention this, because at the beginning, which is especially the time when an outbreak can be got under control, and perhaps the only time, there may be a tendency to work with the smallest possible margin of men and money. There may be a small saving in such a plan at the moment. But it is apt to be a most costly economy, and to be followed by a dragging string of cases, or even by a big outburst, which, from the direct loss of life, the dislocation of business, and the great outlay for measures which ultimately become necessary, costs much more than ample measures would have cost at the beginning. True economy is to throw the whole administrative weight upon the mischief at the earliest moment, and, where there is any doubt, to err on the side of excess. It may be that the outbreak is over-attacked, so to speak; sometimes that cannot well be avoided. Even so, it is far The cheapest policy is to cheaper in the end. The throw in every ounce of weight instantly, and to crush the outbreak at the beginning. By way of summary, it is useful to have a handy reference-list of steps which should be taken on the outbreak of smallpox in a district. When smallpox suddenly breaks out, there is little time for thinking; plans must all be ready, and put into instant operation. The main indications are these:- 1. To ascertain the extent of the existing mischief, and its origin. 2. To eradicate the existing mischief. 3. To arrest its further spread by watching for fresh cases, and rendering them harmless as they occur. Among the detailed steps which have to be taken are 1. "Telephone the case away," i.e. summon an ambulance, and arrange for the patient's immediate removal. It is useful to give instructions that the time of removal of patient, or any delay in removal, be at once reported to you. 2. Communicate with the certifying practitioner, and obtain all particulars possible. 3. Despatch staff to the spot to make inquiries, to superintend the patient's removal, and to carry out disinfection. 4. Advise the vaccinating officer or public vaccinator. 5. Personally proceed to the spot, and ascertain extent of existing mischief. 6. Obtain the history of the source of infection. Obtain from patient or friends (1) a note of his movements at time of infection, and ascertain G who may have given it to him; and (2) a note of his movements after his illness began and ascertain to whom he may have given it. 7. Obtain list of contacts. 8. Push further inquiries as to workplaces, schools, laundries, and other similar collections of persons. 9. Offer re-vaccination to contacts, and, if necessary, by house-to-house calls. 10. Make house-to-house inquiries, if necessary. 11. Bring vaccination of smallpox staff up to date. 12. Consider notification of chickenpox. 13. Consider sending information of cases to practitioners in district. 14. Arrange for medical supervision of contacts. 15. Warn heads of common lodging-houses, casual wards, workhouses, infirmaries, hospitals. 16. Advise public health colleagues in neighbouring or other districts about contacts proceeding thither, and about other material facts. 17. Make reports to proper authorities. Other measures may be necessary, and will be dictated by the special circumstances of the It may be necessary to open local case. |