The history of small-pox in Australia, 1788-1908 / compiled from various sources by J.H.L. Cumpston.

  • John Cumpston
Date:
1914
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Licence: Public Domain Mark

Credit: The history of small-pox in Australia, 1788-1908 / compiled from various sources by J.H.L. Cumpston. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    The absence of definite information is unsatisfactory, and prevents any exact conclusion. That the first half of the decade 1880-1890 was characterized by the somewhat extensive distribution of small-pox over Australia will be dis- cussed at greater length elsewhere. It will be opportune at this point to raise the question to what extent was the presence of the disease in Sydney responsible for its presence elsewhere ? One would be quite justified in expecting that the epidemic occurrence of a disease among a large population which had hitherto been, practically speaking, free from the disease would reveal facts of fundamental importance in connexion with the epidemiology of the disease, and yet whether it be the barrenness of the records, or the sterility of the epidemics as regards instructive lessons, these extensive outbreaks of the disease have revealed only two or three facts. It may, of course, be that these are the essential, and, conceivably, the only essential facts which clearly emerge from the data provided, but in any case they are of fundamental importance, and they may be briefly stated as follows :— (1) The disease throughout displayed a low attack rate. (2) The very prominent position which must be accorded to direct personal contact as one of the principal, if not the controlling factor, in the spread of the disease. (3) The very definite absence of any indication of any other factor. Dr. Ashburton Thompson, in an address before the Royal Society of New South Wales (.see Transactions, 1887, p. 230), in discussing the 1881-2 epidemic, expresses these propositions in the following way :— To some casual local spread of contagious disease two conditions alone are necessary, viz. ; the presence of the specilic contagium, and of personal and local susceptibility. Against epidemics of small-pox thus arising (I speak now of shore populations), our limited quarantine, or policy of isolation with vaccination, is doubtless a sufficient pro- tection usually, that is to say—when members of the quarantine service are themselves also rendered invulnerable by vaccination and re-vaccination. But to pandemic exten- sions of disease, at all events, and probably therefore to any wide and uncontrollable spread even in a particular city, a third condition is necessary. What this is, is not yet known, although it may fairly he supposed to consist in conditions which prolong the life of the contagion after it has parted from the animal body in which it was propagated. But its existence may be inferred from the observation that whereas small-pox is endemic in many places, yet it becomes formidable only from time to time. Now, if such accessions of virulence were merely local, they might be accounted for by accumulation of susceptible persons, newly born for the most part since the last pre- ceding outbreak, when the then susceptible either got immunity after suffering, or were killed off. But it is not in isolated spots that such accessions are observed as a rule: on the contrary, many widely separated places begin to suffer about the same time, and hence it must be concluded that a third, not local, condition is necessary to them. This being so, if we have hitherto escaped any serious epidemic of small-pox here, clearly that is because the third condition has never coincided with the other two. For we exhibit a full measure of personal susceptibility, since, as I calculate, there are at present in this city alone, at least 100,000 unvaccinated persons, reckoning only those who are under 20 yeirs of age : while the specific contagion has often been introduced, and must continue to be introduced from time to time in tne future, in spite of the greatest possible watchfulness at quarantine, and in spite of the arrest of all but a very few undis- coverable cases. The outbreak of 1SS1 seems to me a conspicuous example of the absence of the third condition, for though there were then in the city, 1 reckon, not less than 23,400 unvaccinated children under 5 years of age alone, and although the eontagium remained alive and active for about eight months, yet no more than 154 persons are known to have suffered out of a population of about 228,000. (Dr. Thompson then reviews the salient features of the epidemic as these have already been dct died above).