The Smallpox Campaign

Kai Tiaki : the journal of the nurses of New Zealand, Volume VII, Issue 2, 1 April 1914, Page 82

The Smallpox Campaign

Many roaders of our Journal may bo pleased to know a little of the extensive organisation carried out by the Health Department for the stamping out of this — even if it was m a mild form — repulsive disease, Avhich had gained such a footing before it was realised that we had smallpox amongst us. The first cases were reported from the lower Mangakahia Valley, some distance north of Whangarei, at the end of April, having been introduced by a Mormon elder recently arrived from overseas, whose case developed just after he landed, and while he was taking part m a big Mormon gathering of Maoris m that district. He is believed to have contracted it from the steward on the Vancouver boat who, it is said, introduced the disease into Australia. Although the onset of the illness, the appearance of the postules, with even the secondary fever m some cases, were considered by many medical men as most suspicious of the disease, the cases were mostly at first so mild — that is to say, though covered with very typical postules, m some cases confluent, the symptoms of illness seemed not to be sufficiently severe as to warrant a diagnosis of smallpox. However, it was soon apparent, especially from the immunity towards it enjoyed b}' the recently successfully- vaccinated that the first suspicions of some of our medical men were correct. From Mangakabia to the kiangas behind Helensville the disease spread — carried by travelling Natives — then to Onehunga, Mangere and Auckland, where Europeans also contracted it. In, May the Helens ville-Kakanui cases were regarded as very suspicious, and as many as could be found were vaccinated. We were also on the spot — with all the people m the kainga under instructions to remain where they were — and also all equipment at hand to start an isolation camp ; when word was received that the disease was not smallpox, and that we were to return. There were then about thirty

cased at Kakanui. One infant of/, two months had 4 died ; when we saw it the body was covered with postules. It was soon after this that other oases developed, m town and at Onehunga, and reports came in^of the^ alarming spread of the disease in^various^country districts. The Health Department realised that it was smallpox which had to be fought and got to work m earnest. Extra vaccinators were appointed and sent all over the country vaccinating. The Maoris responded well, and made few objections to vaccination — unlike many of their Pakeha brethren . Sanitary inspectors — many extra were sent to arrange for isolation of patients and contacts. Many Maoris belonging to the Maori Councils andj^Komiti Marae acted as inspectors and did splendid work. Where cases required nursing, camps were formed, with nurses m charge. The nurses' duties being often out of the usual routine, as well as nursing the patients they did vaccinating, arranged for provisions for contacts and those isolated, and rode from kainga to kainga seeing that none were breaking quarantine, also fumigating and disinfecting. Under much adverse criticism, the Hospital Boaid's isolation hospital at Port Chevalier was opened as a smallpox hospital, and before the fiist week had elapsed had over twelve patients m charge of Nurses Grill and Begbie, with Dr. Spedding as medical officer. The buildings soon proved inadequate and tents and marquees were requisitioned straight away. Although almost m town, it was at first necessary for the nurses to rough it pretty much as they must m back-block temporary hospitals. It being winter, the Point Chevalier Road very bad, and the nearest telephone a mile and a half away (the doctor, of course, was not resident) and some of the patients very ill— one died — it can be imagined that the anxieties were many. Every day the number of cases increased until for some time it did not fall below sixty. Convalescents assisted the nurses, and during the whole conduct of the hospital from

June till October the staff didjnot number more than two trained nurses, one untrained nurse and two porters. Good management ensured the necessary attention and nursing for all who required it. Had not the epidemic been m most cases m a mild form, it could not have been possible to manage with so few nurses. Sanitary inspectors were ceaselessly at work m town also, disinfecting and seeing to the quarantining of all contacts ; the police often assisting. In many cases people who were visitors to town found themselves quarantined with limited means ; these had to be provisioned and their movements watched. The only patient lost at Point Chevalier was an old Maori woman, who had the disease severely . With most of the cases eye affections were present, and often all the mucous membranes were more or less invaded by the pustules, m many cases swallowing being difficult for some time. Everyone knows what a rush for vaccination theie was at first, it being difficult to supply lymph quickly enough . Th c vaccination depot m town run by the Department, with Nurse Cairns m charge — certain doctors attending at different hours of the day — owing to numerous letters from anti-vaccinationists appearing m the papers was not taken advantage of as it might have been by Europeans. Should New Zealand ever be visited by a smallpox epidemic m a severe form, it will not be the Natives but the Europeans who will contract the disease. The same measures were being used m the country, the winter roads, particularly m the North, adding greatly to the difficulties of the workers. Assisted by Dr. Buck (Te Rangihiroa), to whose influence with the Natives is to be attributed most of our success m, getting the whole power of the Maori Councils and their various Komiti Marae (village committees) which are working loyally with us, the campaign in'' the North was quite a far-reaching organisation. From Auckland to Waipapakauri, which was the farthest north affected kainga (about forty miles south of North Cape), there were few unaffected kaingas. Kaikohe was selected as a base of operations for all work north of Whangarei, and a large temporary hospital was estab-

lished there. The hospital itself was m charge fpi Dr. Cawkwell and, later, Dr. Jessie Scott and Sister Davison, who had two nurses to help her during the busiest time, when there were over fifty patients. Dr. Buck organised and worked the outdistricts, all being headquartered at Kaikohe, the out-workers reporting there to Dr. Buck as often as possible. The school — a large Native one — was commandeered for the patients to begin with, and the back portion of the teacher's house to accommodate the nurses. Very soon this was quite insufficient, and bad weather notwithstanding, tents and marquees had to be requisitioned. The school-grounds soon presented quite a busy and military appearance, which struck me very forcibly the first time I rode m from my outpost work at Hokianga, twenty miles away. The site of that school at Kaikohe is a beautiful one for a hospital. It is on sloping ground, with little hills rising beyond it to the South and West, on top of one of which is Hone Heke's monument, elected by the Government. Cooking was at fust tried m the schoolhouse kitchen, but the range was broken, so the school fire had to serve for some time ; patients and staff had to subsist on " boils " and camp-oven cooking. Later, a kitchen of corrugated iron was built by the inspectors and students, everybody doing everything he or she could to help — from digging, wood-chopping, pumping water, coffin-making (luckily only required on two occasions) to cooking and nursing. A cook was engaged : he was an expensive and exacting potentate, a real Arab, rejoicing m the name of Ali ; but he could cook, and " other " things were thanufully endured on that account. The camp was divided into two areas — infected and clean. To the former only those m attendance, and patients were admitted, the doctors wearing special clothes on these visits. Convalescents did the domestic part of the work there. In this area were : the school, the play- shed (one end of which was partitioned off as quite an effective fumigator — it was m constant. use), a large marquee and several other smaller patients tents, a nurses sleeping marquee, a disinfection tent, where convalescents after baths were again bathed and given clean clothes before being discharged.

Just outside the barrier m a paddock by itself was the observation tent, where " suspicious ' ' cases were admitted. Patients' clothes were washed m the infected area by convalescent patients, and after being well boiled they were taken away m clean tubs and linsed and hung out by others m the " clean " area. A barrier divided the infected area from the clean, where was first the school-house, more room? of which were taken possession of, where the Sister and Dr Scott, also iS Carrie," a sweet Maori girl who has assisted our own nurses m typhoid camps, slept ; f the mess-tent, a large marquee where doctors, students, sanitary inspectors — -pakeha and Maori — dined ; doc* tors', students', inspectors', and the " clean womem' sleeping tents ; a " clean linen " tent, disinfectant tent ; the office tent, which looked very business-like, kept m excellent order by Inspector Middleton, who acted as steward for the camp. In this tent both a Government and a Maori telephone were installed, and commurication was kept up constantly with every possible kainga and village wheie a Komiti Marae existed ; by this means there was no delay m dealing with any suspicious case reported ; a workmanlike table and chairs, all cleverly made out of pack-ing-cases ; and Mr. Middleton's stretcher. He slept there, and was often called up to get a meal for a tired-out contingent riding m at all houis of the night and moining. For this sort of thing " Perfection " oil stoves were splendid institutions — indeed, we find them indispensable m all temporary hospitals — and many a tasty meal of bacon and eggs with (invariably) pint mugs of tea was enjoyed on these occasions by famished workers — often the first meal for hours or more. The last tent near the gate was the vaccination tent, and past this visitors were not allowed. It was not long before the school tanks proved insufficient for water supply, and water had to be pumped fiom a spring m the grounds and carried. This proceeding soon proved impracticable, such quantities being necessary, and emergency pipes were laid to all the tanks, all hands taking a hand at pumping from time to time. When it rained the whole staff indulged m a bath ! At other times they were a "thought" and taken with discretion.

The system of "working off the infection," instituted by Dr. Cawkwell, was a most thorough one. Nothing m the clothing line was considered safe unless boiled. Men's suits had to be either destroyed or rendered unfit for wear by the owners. Much clothing had to be replaced to the Natives, and for this purpose an appeal was made to the public, which was very generously responded to. (I might add that some of the " tiyings-on " attendant upon these replacings created much fun.) Tents, blankets, mattrass covers (straw was used and burnt afterwards), pillow tickings (all of these had to be emptied, of course) ?11 had to be boiled. For this purpose a large iron tank was made — on the premises — and set over a long trench m which a fire was lit ; m this way forty blankets were boiled at a time ; on another occasion the largest marquee. Sad was the day when the heat caused some of the solder to melt, and the tank would no longer boil the big things. However, the largest number had been done by that time and the smaller tents and flys had to be done one end at a time m the copper. You would be surprised to find how little boiling really injures blankets, except that the colour " ran," they seemed none the worse. Nc one who worked m the infected area was allowed m the clean linen tent or to touch anything once received after disinfection. Patients were discharged immediately from the disinfection tent. Most of the cases were admitted m the, pustular stage, but others were seen m the earlier stages, and, from the history of most, the symptoms of onset were either fairly typical or very mild. Many were pitiful sights m the pustular stage and are permanently disfigured. Some required a great deal of nursing for a time, frequent swabbing all over with weak lysol giving great relief. Eye irrigations were necessary m most cases and good nourishment frequently. Once at the scabbing stage convalescence was quick, but children had to be watched to prevent their scratching off the scabs before the pustules had healed underneath. No one was, of course, safe to be liberated until every vestige of scabbing or scaling had disappeared. Although so few died actually at Kaikohe Hospital, m the districts round there were more, especially on the Kairara gum-

fields, where the conditions of living were very bad. About twenty five of the known forty deaths occurred m the North. A small camp was run at Waikare, Bay of Islands. Nurse Ellen Taare had charge of that for some weeks, the Maoris there assisting Sub-Inspector Sim, who did the disinfections and scouted round the kaingas to secure quarantine of contacts, etc., splendidly. I could not imagine a worse case of smallpox anywhere than that of a fiae old Native named Mita Kaa, who died at Waikare camp ; although all of the other cases there had it mildly. At Kaihu Dr. Ross and Inspector Galloway directed a large camp of patients and contacts. Dr. Duncan and Nurse Fairland, assisted by Archdeacon Hawkins and Inspector Grieve, had camps at Atupara and Waipapakauri, the former being on the top of a high hill on the gumfields, the track up was most difficult to negotiate. Nurse Fairland had never ridden before, but rode the sixteen miles from Kaitara to this camp splendidly, and, returning, rode more than forty miles back to Mangonui. Nurse Kittlety had charge of the cases at Poroti, some distance out from Wanggarei. She was camped m a school-house where she " farmed " for herself and went round to her patients each day on horsebackj attending to them and seeing that they and contacts kept quarantine. At Hokianga there were forty cases when we arrived on the scene, but all almost over the worst. No camps were formed there, there being only one suspicious case after we took them m hand. This was removed to Kaikohe, but turned out to be only an indigestion rash. The roads to be negotiated daily between these kaingas were very bad. The quarantine restrictions were particularly hard on the Natives there and stores had to be issued to them m quantities. Never shall I forget the " butcher's shop " conducted under a tree near the roadside every Saturday, when a ' beast ". was divided between two hundred and sixty people. They had eaten almost every pig m the place. No Europeans would employ any of them to work, and their slender means had melted away ; nevertheless, there was lots of fun when all the " customers " turned up.

The comic artist could have kept his '^weekly." well going with^apt pictures^and glib sayings. In the Waikato many of the cases were very severe. Six died at Maungatotara, near Cambridge, and one or two at Parawera, where Dr. Gunn and Nurse Wigney had a camp. There were deaths also at Taupiri — it was there that a very promising young Maori clergyman named Marsh died. He was attended by Nurse Wilkes, of the Church of England Mission at Gordonton. He is said to have had haemorrhagic confluent smallpox and was m a pitiable state when he died. Another very sad case died m a kainga near Taumarunui, attended by a man who nursed him very devotedly. At Tauranga Nurse Mataira had charge of a camp, assisted by a Miss Wing, who had helped Nurse Wigney at Parawera. Most of the Bay of Plenty cases have been of a mild nature, no deaths having occurred ; but the same isolation and disnfection was of course necessary as for the bad cases, but many required little or no nursing. In cases where the rash was profuse, the irritation caused much suffering, and it was not easy to keep them from scratching the pustules, which would then, of course, bleed. Some cases, seen before any treatment had been used, presented the appearance of huge areas of ulcer or sloughing burn, the scabs having been scratched off as quickly as they formed. The pustules were generally well-defined, though, and where not confluent, regular m shape. The rash was generally oldest on the face, which might be scabbing off, that on the legs, thighs and back being the most recent. It was generally well marked on arms, hands and feet — even palms and soles. The smell of a bad case is never to be forgotten. You can imagine the care and gentleness required m handling and turning such a patient — where there is no whole part of the body to touch. The least affected parts seem to be the chest and abdomen. You can also imagine the state a neglected case could get into through want of being turned. The best way to manage is for two to do it — one manipulating the patient with the draw sheet, the other supporting, perhaps, the upper

most shoulder and buttock at the iWin, with large swaks of wool wrung out of warm lyso] held m the hands. We dreased the worst parts, after swabbing, with something soothing, as boracic ointment or vasejine, lightly securing the dressing. Jeye's Fluid swabbiugs seemed also to greatly allay the irritation. The case before referred to, that of the old Maori at Waikarc, m addition to the extensive area covered by these awful bleeding pustules, had pustules m mouth and throat, causing inability to take nourishment or swallow. No doubt, with the great prostration, this accounted for his low condition when admitted, although he had only been ill a little over a week. There were many pustules also m both

conjunctiva?, and sloughing of the cornea had set m when we got the patient ; before ho died he was quite blind. I think this was absolutely the most revolting and distressing case I have ever nursed, and the patience and gratitude of the fine old Maori to the last was most touching. The sub -inspector, a convalescent patient and myself made the coffin for this patient. While we did so his body was wrapped m disinfectant sheets and placed outside under an awning, where his poor old wife sat beside him weeping and " keening " m the sad Maori way. She had been with him all the time, and was very gooel, and, strange to say, did not contract the disease, although five successive vaccinations had all proved unsuccessful.