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33
1930
weeks previously. He had seen a doctor who had diagnosed
Chicken-Pox. When the "Chicken-Pox" patient was examined
at the end of June, it was evident that he had had Small-Pox.
During his illness he had not been confined to the house, but
had wandered freely about the district. He had probably been
in contact with hundreds of people and any attempt to trace the
contacts was impossible, and yet, as far as can be ascertained,
no further cases resulted.
The third outbreak occurred in North Acton. This was, of
course, the fourth case in the district. It was notified on July
26th, and the rash appeared on July 20th. It is almost certain
that this patient had been in no way connected with the previous
cases in Acton. Her husband was employed in one of the local
factories, but no illness resembling Small-Pox occurred amongst
the other employees. Her sister from Crayford had visited and
the patient had been in London on several occasions. The source
of infection, though was not traced. This again, was a fairly
simple case. She was confined to bed from the date of the
eruption of the rash and no one outside the family had visited
her. The contacts were easily traced and the only other case
which occurred was a daughter.
The fourth importation was in August, and the case was
notified on August 15th. On that date he attended the Acton
Hospital as an out-patient suffering from a rash on the face,
which was diagnosed as Small-Pox. The patient had mixed with
a number of persons, and the list of contacts was very incomplete.
No further cases occurred.
During the summer months the infectivity of the disease
appeared to be a low one. Several other instances could be given.
A case was notified in Chiswick. He was employed in a factory
in Acton and he had been at work for two days after the appearance
of the rash. He had been in immediate contact with a score
of people, in probable contact with another score and in possible
contact with about 500 persons. It was impossible to visit the
houses daily of all these and supervision had to be exercised
through the factory. No other cases occurred, and the immunity
was not due to recent vaccination or re-vaccination.
In contrast with the low infectivity of the disease during
the summer months, has been the high infectivity of the disease
in December. A case was notified on December 13th. She was
one of 5 Small-Pox contacts which had been forwarded from
Hammersmith. It appears that a missed case had occurred in that
borough, and was discovered through a notified case early in
December. On December 6th, the Medical Officer of Health of
Hammersmith received a notification of Small-Pox. On enquiry
he found that another inmate of the same house had had a rash
about the middle of November, and the case had been diagnosed
as Chicken-Pox, but which was undoubtedly Small-Pox. During