Page 31
Smallpox.
102. Every year during the winter months this disease manifests itself in outbreaks which are sometimes sporadic sometimes epidemic. Whatever be the prevalence there is always a tendency for the morbidity rate to decline or disappear with the advent of summer. Considering its high infectivity, its terrible disfigurement and the frequency of fatalities, the indifference shown by the Chinese to the presence of cases in their midst is amazing. All Chinese know smallpox and the presence of a case in a crowded tenement house cannot escape the notice of the occupiers, but for some obscure psychological reason they refrain from reporting its presence to the authorities, and more often than not the first notification received by the Medical Officer of Health is that from the Mortuary where the body, dumped in the street at night, has been taken for diagnosis. The sole information received by the Health Authorities concerning the case is the sex of the deceased, the apparent age and the diagnosis. The name, the address, the number of contacts and the period during which the case has been a focus of infection are unknown.
103. After the 1916-1917 epidemic, in an endeavour to stop the practice of dumping and to encourage notification of cases, the Sanitary Board passed a resolution—that patients suffering from smallpox be allowed to be treated in their own houses provided that:
(a) all cases in the district be notified to the Medical Officer of Health.
(b) all inmates of the houses be vaccinated.
(c) a notice be posted on the door of the house where the patient is being treated.
104. The results did not come up to expectation for the populace ignored the concession and continued their practice of concealing cases and dumping corpses.
105. During 14 years of trial, 1917-1930 inclusive, 5,428 cases and 4,711 deaths were brought to the notice of the M.O.H. The case mortality rate calculated from these figures was 86.79 per cent, much too high for a population which has no objection to vaccination. The obvious explanation is that many cases escaped the notice of the authorities altogether. Allowing that the death rate was 50 per cent there were 10,856 cases. Less than 5 per cent of the cases were notified early, 25 per cent were notified when the cases were moribund, 40 per cent after death and 30 per cent escaped detection.
106. From time to time the M.O.H. reported as to facts and in 1930 the Board appointed a Committee under the D.M.S.S. to investigate and make recommendations. The Committee recommended that the concession should be cancelled and in February 1931 the Board rescinded its resolution of 1917.
Page 31