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13
*Smallpox.
Information was received from the Medical Officer of Health of another London
Borough that a German business man stayed in a hotel in his area and was subsequently
confirmed as a smallpox case. A member of the staff of the hotel was a
contact of this case and resident in Islington. On investigation he was found to
be in good health and was kept under observation for the usual period.
The Medical Officer of Health was also notified by the Royal Northern Hospital
that a Nursing Sister who was a contact of smallpox cases in Gibraltar had
returned to this Country by air. As it was her intention to travel to her home in
Warwickshire, information was transmitted to the appropriate Local Authority.
Nine visits were paid by the Medical Officer of Health, or Deputy Medical
Officer of Health to suspect cases on requests by family practitioners. Eight of
these were not confirmed, but the remaining case was most exceptional and some
serious consequences ensued. The Medical Officer of Health was called in to see a
patient with a haemorrhagic rash. He was extremely ill and, although admitted to
hospital almost immediately, died within a few hours of admission. Following a postmortem
examination, he was diagnosed as acute leukaemia. Some five weeks later,
a six-year-old child in a neighbouring borough was diagnosed as a case of smallpox,
from which, unfortunately, he died ; he was unvaccinated. The only possible source
of infection appeared to be his grandmother who was doing domestic work in the
hospital where the post-mortem examination of the patient first referred to was
carried out and who herself contracted a rash which was thought to be chicken-pox.
Another relative of this family also contracted an illness which was diagnosed as
smallpox, but both the adult cases had been vaccinated in childhood and recovered.
Retrospective enquiries elicited information that the Islington patient had, about a
fortnight before becoming ill, visited a relative in another area who had a sick child,
vaccinated in infancy, and thought to be suffering from chicken-pox. Her father,
who was well vaccinated, had previously had a slight illness following his recent
return by air to this Country from Nigeria. This possible chain of transmission,
found retrospectively, appeared to be the only one which accounted for the introduction
and spread of the infection.
Although very fortunately the cases were few, extensive enquiries and precautionary
measures were necessary in the areas affected. All possible contacts living
in the Borough were offered vaccination through the Divisional Medical staff of the
County Council and family practitioners. 88 persons were vaccinated by Dr.
Simpson of the London County Council ; 60 by their family practitioners ; 23 at
hospitals, and 16 others at their places of employment or at a clinic. Precautionary
vaccination or re-vaccination was offered to the Public Health Department staff
exposed to infection risk, and the Deputy Medical Officer of Health carried out 54
vaccinations, making a total, in all, of 241 vaccinated persons. Daily domiciliary
follow-up visiting of all contacts was arranged and close liaison made with practitioners
concerned. The staff of the Department carried out over 600 visits and
rotas for emergency calls and evening visits were in operation during the quarantine
period.
The following is the table of successful vaccinations performed over the past
ten years—