Memorandum by Dr. R.J. Reece on considerations adduced by Dr. Hope in reference to a report by Dr. Reece on smallpox and smallpox hospitals at Liverpool, 1902-3 / Richard J. Reece.

  • Great Britain. Local Government Board.
Date:
[1905]
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Licence: In copyright

Credit: Memorandum by Dr. R.J. Reece on considerations adduced by Dr. Hope in reference to a report by Dr. Reece on smallpox and smallpox hospitals at Liverpool, 1902-3 / Richard J. Reece. Source: Wellcome Collection.

Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.

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    (Priory Road) in the early portion of the epidemic, or the figures for the outside (Fazakerley) hospital with comparatively few houses round it, each basis of consideration indicates in its degree and on the invasion rates, a like specialised incidence corresponding in point of time to the hospital operations. Furthermore, where the figures are largest, and the conclusions to be drawn from the rates are consequently the most definite, the indication of the excess of incidence, and the graduation of incidence, are clearly manifest. It is reading into my report that which is not there to represent that I state distinctly there is only one explanation of smallpox incidence round hospitals, viz. : dissemination of infection by aerial convection, and that I ignore all the considerations upon which so much stress is laid by Mr. Power and other observers. Those who read my report carefully will see that it is limited, so far as prevalence of smallpox around the hospitals is concerned, to the three considerations set forth above, and that I offer no explanation as to the cause of this prevalence ; the statements in the report are strictly limited to observed facts. My provisional attitude with regard to aerial convection of smallpox infection is set forth on pp. 9 and 10 of my report as follows :— “ Experience of the sort in question, which is well known, has demonstrated that excessive incidence of smallpox on populous areas in the vicinity of a hospital receiving a plurality of acute cases of the disease is no unusual occurrence, and it can hardly be doubted that the relationship between the operations of these hospitals and the excessive smallpox incidence in their neighbourhood is one of cause and effect. Further, it has been strongly indicated from careful study of various instances of “ smallpox hospital influence,” that explanation of extra incidence of smallpox around such hospital, by assumption of hospital mismanagement or of lack of precautions in regulating the necessary traffic and business of the establishment, does not suffice to account for the facts. The generally accepted and, so far as 1 am aware, the only completely satisfactory explanation of the peculiarities of smallpox incidence around hospitals receiving acute cases of the disease, is dissemination of infection by aerial convection ; an explanation introduced many years ago by Mr. W. H. Power, the Board’s present medical officer, after detailed study of the behaviour of smallpox around Fulham and other London hospitals. He held that particulate matter capable of conveying infection, escaping into the air from the wards of a smallpox hospital, does on occasion and in suitable atmospheric conditions become wafted to considerable distances from such hospital. “ Hospital influence ” in this sense has been traced in certain instances, where circumstances allowed the study to be made in respect of inhabited areas, as far as one mile from the hospital ; by some observers it has been thought to have been traceable, though to a much less degree, on inhabited areas situated even further than a mile from the hospital. It has not, of course, been affirmed that, whenever acute cases are admitted to a smallpox hospital situated near a populous area, demonstration of aerial convection will certainly be forthcoming if only the facts be strictly studied. There is ground indeed for belief that a smallpox hospital in a populous area does not, as a result of its actual operations, always, whether aerially or otherwise, distribute smallpox in conspicuous fashion in its neighbourhood ; and perhaps opinion has come to be entertained in some quarters that disadvantage such as accrued from Fulham and other smallpox hospitals may be regarded as the exception, not the rule. Similarly there has, -when emergency has resulted in compulsory use as it were for smallpox of a hospital in a populous neighbourhood, arisen a tendency to minimise any mischief which may be alleged to be due to the hospital. A demonstration, therefore, of absence of spread of smallpox from hospital in the case of Liverpool, where three hospitals, two of them in the City, were receiving acute smallpox cases, and where in particular one of the hospitals (Park Hill) for a period of some 24 weeks at the height of the epidemic received acute smallpox patients in large numbers, would, if established, be not only particularly interesting to epidemiologists, but in its administrative aspects would be reassuring to smallpox hospital authorities.” My personal belief, if it be desired that I should state it, is that aerial convection probably operated in the case of each Liverpool hospital. The data placed at my disposal by Dr. Hope give little suggestion of support to the proposition that infection had occurred in the neighbourhood of any of these hospitals as a result of communications or traffic with the hospital. At most two or three instances of possible infection in this way have been traced. The assumptions required to explain the excess of incidence and the graduation of