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year, 142 members of the staff of the department were vaccinated or revaccinated.
Information was received during the year from port authorities of 211
persons intending to stay in the borough and who could not produce valid
certificates of vaccination after leaving countries which were declared
local infected endemic areas. Of these, 138 were kept under observation
for the surveillance period and remained quite well. Six were found to
have moved to other areas, and the local Medical Officers of Health were
notified.
The staff were unable to trace the remaining sixty-seven persons at
the addresses given by the port authorities.
On Saturday evening, 24th February, 1968, a fifteen-year old
Pakistani boy from Karachi (possibly vaccinated on 17th February, 1968)
arrived at London (Heathrow) Airport, where he was met by his father and
proceeded to a lodging house in Cromwell Road. On Monday or Tuesday, his
father departed on a pilgrimage to Mecca. The boy is believed to have
stayed at the Cromwell Road address until Thursday morning, 29th
February, 1968. On Tuesday, 27th February, however, feeling ill
(T. 103.00), he visited relatives in Wardour Street, Soho, who took him to
see a general practitioner, who diagnosed a urinary infection. He
probably visited the Soho address again on Wednesday, 28th February, and
certainly did so on Thursday morning, 29th February, 1968. As a rash
had now appeared, he re-visited the doctor who suspected smallpox. This
was confirmed clinically by the Westminster City Medical Officer of
Health and a smallpox consultant. The boy was removed to Long Reach
Smallpox Hospital, Dartford, the same day, the diagnosis subsequently
being confirmed by serological demonstration of the virus antigen by the
Agar Gel diffusion test and virologically by isolation of the virus on
egg culture. Subsequently, he made a satisfactory recovery from a
fairly severe attack of a virulent type of the disease, which had been
partially modified by vaccination.
The case first came to the notice of the department on Thursday
evening, 29th February, 1968, when the Public Health Inspector on
emergency duty immediately visited the Cromwell Road premises to
ascertain the local circumstances, the extent and duration of infection
risk, the names, occupation, vaccinal state, and movements of contacts.
The lodging house is a large five-storey and basement Victorian
terrace house, let in single rooms, mainly to male Pakistanis engaged
as managers, cooks, waiters or kitchen hands. Their places of employment
included a bakery, a canteen, a public house, an hotel, a food depot
and twelve restaurants. Also in the house were two Chinese families,
including three schoolchildren. A considerable amount of trouble was
experienced in all the enquiries by reason of difficulties in finding
the lodgers, most of whom worked very early, late, long or irregular
hours. Many, having little, if any, communication with their fellow
lodgers, had no information to give; others were reticent or reluctant
to communicate information. The main obstacle, however, was connected
with language difficulties. Fortunately, a member of the department
speaks Urdu, which was either spoken or understood by many of the
Pakistani occupiers. This officer gave great assistance in questioning
all the people in the house, in the subsequent medical examination of
the immediate contacts, and in facilitating the many vaccinations
which had to be undertaken. Written instructions were given to all the
occupiers concerning the action which they were to take if they had any
one of a number of specified symptoms. These instructions were issued
in English with a translation in Urdu. I was also fortunate to have an
officer who spoke Chinese and wrote the script. With her assistance,
I was able to issue written medical instructions to the Chinese
families in English and Chinese.