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THE ADMINISTRATIVE

CONTROL OF SMALLPOX

CHAPTER I

GENERAL REVIEW

EPIDEMICS of infectious disease are compared to conflagrations. The comparison is just. Especially striking are epidemics among island populations. There are, for instance, the wellknown outbreaks of measles in the South Seas. Prior to the year 1875 the Fiji Islands had been free from that disease. But the population was highly susceptible. In December, 1874, the native chief Thacombau had measles while on a visit to Sydney. On the voyage home in January, 1875, one of his sons and a native attendant fell ill of the same disease. They landed. Another of the chief's sons sickened. Visitors

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thronged the houses where the sick people lay. Infection was spread broadcast.

There was furious outbreak. Whole villages were attacked, their inhabitants being nearly all smitten at once. Food could hardly be obtained, or, if obtained, could not be cooked, because no one was well enough to cook it. In the midst of plenty, people died of exhaustion and starvation. An end was put to the epidemic only when the infectible material was exhausted, that is when nearly every person had been attacked. By the end of May, 1875, there had died about one-fifth of the population, that was about 20,000 persons.

Recently there has been a similar tragedy. Rotumé, another South Sea Island, was similarly swept in 1911. The transactions of the Epidemiological Section of the Royal Society of Medicine for 1913 inform that the Resident Commissioner, a medical practitioner, was obliged to go on leave. In his absence a case of measles was landed. Again infection spread with great rapidity among the population, which here numbered about 2000 persons. Of this number about 350 persons died.

Epidemics such as these are paralleled in our

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own islands by the Black Death of 1349, which is believed to have destroyed one person in every three. In each of these cases and in many others, the conditions were, that into an island population of a high degree of susceptibility there was imported a highly infectious disease ; and the result was like that of a spark falling in long dry grass. A furious conflagration raged, till all that was combustible was burnt

up What is the state of the case, in regard to smallpox, in our own islands and in many other communities? It is important to get a just view of the position; for upon it is based the whole rationale of keeping smallpox out as long as possible, and of stopping its spread when it has obtained an entry.

The position is something like this. We may imagine a huge stack of fuel composed of small bundles of brushwood or firewood. Some of these bundles are as dry as tinder and are very inflammable. Others are very damp and in no danger from fire; others again are in a condition between these two extremes. We may further suppose that the various bundles are not regularly arranged as regards their degree of dryness ; in one part

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