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36
On the 20th September I saw the case in consultation with his
medical attendant. The patient was in bed, apparently very ill.
He stated that his illness began on the evening of the 16th with
pains in the back, which he attributed to rheumatism. On the 19th
the pain became worse, and he called at his doctor's on his way home
from his work. On examination patient was evidently suffering
from severe lumbar pain, and could move in bed only with difficulty.
His face was flushed. There were two well-marked initial rashes
present, a bright erythematous rash on neck and trunk and a very
well marked petechial eruption in the groins and the upper and inner
aspects of both thighs and extending upwards to the costal margins
to the axillae of both sides. There were no focal lesions present.
The case was diagnosed as hæmorrhagic Small-pox, and the patient
was at once removed to hospital where he died next day.
The patient was said to have been vaccinated in infancy, but
the evidence of successful vaccination was doubtful.
There appears to be no reasonable doubt but that the patient
became infected while engaged in the removal of infected material
from the room occupied by a previous case in the Metropolitan
Borough referred to.
The case is of particular interest because of the source of infection,
short incubation period, clinical history and rapidly fatal issue.
All precautionary measures were at once taken to prevent the
spread of infection. These included vaccination or re-vaccination
and daily medical inspection of all persons (two families) living in the
house, in the basement of which the patient resided, and of all contacts
at the works where he was employed and elsewhere. Fortunately,
the particular work at which he was engaged did not bring
him into immediate contact with the large number of workers
employed at the firm's factory in Battersea —a matter of some
importance, having regard to the fact that he continued at his work
for at least the first two days of his illness.
During 1923 there were 12 cases of Small-pox notified in the
County of London.
Scarlet Fever.
Scarlet fever was much less prevalent during 1923 than in
the previous year, the period of epidemic prevalence which began in
1919 having reached its maximum in 1921. The total number of
cases notified in 1923 was 409, as compared with 750 in 1922, 1,374
in 1921, 667 in 1920 and 484 in 1919. The case-rate per 1,000 o f the
population was 2·4 and 6 deaths were registered from the disease,
giving a death-rate of 0·035 per 1,000, as compared with 13 deaths
and a death-rate of 0·077 in 1922 and 6 deaths and a mortalityrate
of 0·035 in 1921.
Of the cases notified, 400 (i.e., 97·8 per cent.) were removed
to hospital. The 409 cases occurred in 339 infected houses.