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53
travel in congested railway carriages each day and knows too of the
number of patients actually suffering from the disease who,
through it being unrecognised, travelled up daily to work.
Most of the cases occurred in the latter part of the year. In
January there were two primary cases, one of which gave rise to
5 secondaries. In February 1 primary, and in March 3 primaries,
giving rise to 7 secondaries. 2 eases in April infected 4 others in
May. There were 3 primary cases in May and 1 in June gave rise
to a secondary. One patient in August infected 2 home contacts
and another in October gave rise to 3 eases. In November there
were a number of school cases. In addition there were 2 separate
primary cases, each of which gave rise to 3 secondaries.
The school infection occurred in one of the old type buildings
which is rather crowded. On 17/11 a notification was received of I
a girl scholar of 6, No. 31, in whom the onset was 13/11, the last
day she attended school. On 20/11, No. 32, a girl of 6 of the same
class was diagnosed. Her onset was 12/11. The school was
visited and all the children examined with a view to discovering
the source of infection. A child G. C., with scars of a typical
distribution, who had been ill, on 12/11 was excluded. Visiting
the absentees led to a family 1)., in whom sonic nicn>bcrs
were suffering and some recovering from smallpox. I'-lf
had suffered and was at school to 22/10. lie had iufcctcd his
brother and his mother. This family was apparently infected by
their next-door neighbours, family I}., who came to this district
about 10/10 from a part of London in which smallpox had appeared
Some members had suffered while in Iiondon and in others the
onset was shortly subscquent-to their coming here. None of the
members of this family at the time of the visit appeared to be
infectious.
On 30/11, No. 40, I. G., a girl of 6 attending the same school,
was attacked. Early in 1931, another case of smallpox occurring
led to the recognition of the fact, that two brothel's F. C. and I. C.
attending this school, had suffered from the illness about 30/11.
Most cases gave rise to at least one secondary case at home.
The history of the outbreak then, seems to have been : (1) Family
B. contracted the disease in London and transferred here
infectious. No cases were diagnosed in the infectious stage. (2)
Family B. infected their next-door neighbours, family D- (3) The
school child of family D. infected at school Nos. 31, and G. C.
(G. C. was not recognised while infectious). (4) Nos. 31 and 32
gave rise to home infections, as did also G.C. In addition one
more of these was responsible for infecting at school (a) F. C. and
G. C. who gave rise to one secondary case at home, (b) I. G. who