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in children who had never been vaccinated. Of the two
cases in age group 25-45 years mentioned as subsequently
vaccinated, one was vaccinated during the late
war and the other about 7 or 8 years ago.
Apart from the one case that died, nearly all the
cases could be classified as mild Smallpox. The few
exceptions that occurred might be termed as severe mild.
The cases which on discovery had a rash almost semiconfluent
in character had generally a history of severe
initial symptoms before the rash appeared.
Sometimes, especially in the very mild cases
occurring in children, it is very difficult to obtain any
dependable history relative to the onset. Quite a
number of children simply complained of feeling tired
on returning from school or the mother noticed that the
child did not appear to be so bright and active as usual.
The most difficult part of the problem in dealing
with the outbreak is the "missed" case. These are
cases which have never been notified and generally have
not been seen by a doctor. As mentioned, in some
children the initial symptoms are so slight, the spots
appearing so few, that the parent, ignorant of the true
condition, does not think it necessary to call in a doctor.
Other cases are thought by the parents to be merely
food rashes and the child continues to attend school.
Others again, particularly adults, mistake the initial
symptoms for a severe cold or influenza and consequently
very often do not trouble to call a doctor since in two
or three days they feel better, get up and go back to
work. They may only have a few spots to which they
pay no attention and so continue working throughout
the period of infectivity. On the other hand, in a day
or two the rash may be more profuse, the patient
becomes nervous and either visits the doctor's surgery
or calls him in.
The source of infection is sometimes traceable to
one of these "missed" cases, but it is impossible to
estimate how many others may have been infected by