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Nos. 3 and 21 were isolated cases, the sources of whose
infection could not be traced.
Of the 33 cases, the source of infection was ascertained
in 27 cases, or 81.8 per cent, of the total number,
and was found to be personal infection by a previous
case. It is possible that some of the remaining 6 cases
were infected by those patients in whom the disease was not
recognised and who, as has been stated above, pursued their
usual avocations without any attempt at isolation.
As soon as the patients came to the knowledge of the
officers of the Health Department, they were at once reported
by telephone to the Metropolitan Asylums Board and were
promptly removed by the Board's Ambulance Department to
the Small-pox hospital. Disinfection of the whole house was
then carried out. The case was reported to the Vaccination
Officer and the Public Vaccinator, and every effort was made
to secure the vaccination or re-vaccination of all persons who
had been exposed to infection. Unfortunately, these efforts
were not infrequently unsuccessful. All persons who had been
exposed to infection were kept under supervision during the
incubation period, and school children were excluded from
school for that period. If any "contact" was found to live
or work in another district, the Medical Officer of Health of
that district was at once informed of the fact by telephone.
All the officers of the Health Department who were
exposed to infection were protected by re-vaccination or by a
recent attack of Small-pox, and no case of the disease occurred
amongst them.
Most of the cases in 1903 were exceptionally slight —not
one was fatal —and for this reason the outbreak well illustrates
the difficulties attending the application of methods of isolation
and disinfection to Small-pox under existing legal provisions
relating to infectious disease. Before a patient can be isolated
and his premises disinfected he must be brought to the notice
of the Sanitary Authority ; but in many cases it is by no means
an easy matter to secure that this shall be done. In the first