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8
possibility of the existence of an unrecognised case in the ward. His attention was directed to one
of the patients (0.0.) in the ward, who was very ill and was thought to be suffering from septicaemia.
Dr. Wanklyn was of the opinion, however, that he was suffering from haemorrhagic smallpox and
advised immediate removal. The man died the next day. On examining a patient (J.H.) in an adjacent
bed who was said to have suffered from "acne" about a fortnight previously (5th April), Dr. Wanklyn
came to the conclusion that the man was recovering from a mild attack of smallpox, there being distinct
evidence of that disease on the soles of the feet. This man was also removed to hospital. On the
discovery of these cases the whole hospital floor was immediately placed in quarantine and arrangements
were made to have all known contacts followed up and vaccinated. The seamen's and common lodging
houses were kept under close observation. Only one further case resulted, viz., a ward dresser, and
therp is no doubt that by the timely detection of these cases and the stringent precautions which were
taken a more extensive outbreak was averted. The source from which J.H. (the convalescent case)
derived his infection could not be definitely traced, as he had been an inmate of the hospital for some
time, certainly on the date when he must have been infected, which from the history was some time
in the middle of March. In these circumstances suspicion fell upon the case of A.L. (Group IV.)
already referred to as having been removed from the Seamen's Hospital on the 17th March suffering
from smallpox. It was ascertained, however, that in the ordinary course of events the two men should
not have come into contact with each other, as one received treatment in the morning and the other in
the evening. In view, however, of the fact that A.L. attended the hospital on the 17th March in an
infectious condition and that J.H. fell ill about a fortnight later the possibility of some connection,
direct or indirect, can hardly be excluded altogether. On the other hand the chances of an unrecognised
case attending the out-patient's department of a hospital when seamen are daily in attendance
must not be ovei looked.
A report of the occurrence of smallpox in the Administrative County in 1920 would be incomplete
without a brief reference being made to outbreaks which developed in greater London, namely, in East
Ham and West Ham, about the same time. Want of space forbids a description of these cases in detail
but theie is little doubt that the infection originated from the docks area. The following table shows
the number of cases notified in greater London and the Port of London, and their distribution, monthly
and geographically The ship cases which arrived in the Port of London were promptly dealt with,
the contacts were followed up, and no developments arose.
Locality.
February.
March.
April.
May.
June.
Total.
West Ham 7 10 6 6 1 30
East Ham 6 1 — 13 11
Romford — — — — 3 3
Ilford 1 — — — — 1
Leyton — 1 — — — 1
Erith — 4 — — — 4
Twickenham — — 1 — — 1
(imported
from Spain)
Port of London.
S.S. China (from Calcutta) — 2 — — — 2
S.S. City of Manchester (from Calcutta) — 1 — — — 1
S.S. Wigmore (from Alexandria) 1 — — — — 1
S.S. City of London (from Calcutta) 1 — — — — 1
S.S. Surf (coasting collier) — 1 1 — — 2
(see table
page 6)
Total 16 20 8 7 7 58
Dr. W. McC. Wanklyn assisted in the diagnosis of 17 suspected eases occurring in the Counties of
Middlesex and Essex and the County Boroughs of East Ha m and West Ham in accordance with an arrangement
previously made. Of these four proved to be smallpox. There is no doubt that the facilities
afforded by the Council to medical practitioners in these contiguous areas for obtaining expert assistance
in diagnosis is of great value, not only to the districts concerned, but also in preventing the spread of
smallpox into London.
Study of the incidence of smallpox in London shows that there has been a notable fall in the
period subsequent to 1885 as compared with earlier years; indeed, since 1885, in only three years have
the deaths exceeded 100, viz., in 1893 (186), in 1901 (229), and in 1902 (1,314); during the last 15 years
only 24 deaths have been registered, i.e., less than 2 per annum.
The question may be raised as to how long it will be possible to keep smallpox at the present
low figure. The answer is that under existing conditions there is a constant risk that smallpox will
strongly reassert itself, and assume a more prominent position than it does at present. A glance at a
world map of smallpox makes this self evident. Smallpox is a world disease, and is very widely prevalent.
In British India, for instance, during the year 1918, there were 93,000 deaths from smallpox, probably
representing half a million cases ; and, as it is more or less prevalent in nearly the whole of the rest of
the world, it is apparent that the total number of cases reaches a very high figure.
In this country, and especially in the metropolis, with its large influx of passenger traffic from
all parts, not only from the Continent, but also from the seaports of the Mediterranean and of the Eastern