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82
one of his playmates led to the discovery of a ' 'missed'' case—a boy who
had had Smallpox about three weeks previously and at the time of his
examination was non-infectious. He had attended school regularly since
the rash appeared. In the household of this "missed" case four other
cases were discovered and removed to hospital. Some of the patients
had been at work and others at school while in an infectious condition.
It was impossible to trace all persons who had been in contact with these
cases, but 25 cases have been definitely traced to this source of infection.
Since then other cases of Smallpox have continued to occur in this neigbourhood,
but it has not been possible to definitely associate them with
the "missed'' cases mentioned above.
In November a case of Smallpox occurred on the Isle of Dogs and on
investigation the source of infection was traced to a barber who, whilst
having a barber's business on the Island, lived in a neighbouring Borough
This man continued at work with a rash for a few days before he was
removed to hospital by the Authority of that Borough. He, however,
did not inform them that he worked in Poplar, with the result that it was
not until other cases began to occur on the Island that this case became
known to us. In all 22 cases occurred in this area during the months of
November and December, and it is highly probable that some ''missed"
cases continued the infection from the month of August, when the barber
patient was removed, until we picked up the infection in a "missed"
case who was ill about the beginning of October.
When investigating the source of infection of cases of Smallpox
occurring during the year, no less than 22 "missed'' cases were discovered
These were non-infectious at the time of examination and are not included
in the 177 cases.
In spite of the efforts made to deal with it, this disease continues to
spread, as only a very small proportion of the population is protected by
efficient vaccination and the disease itself is extremely mild. As will be
seen by the Vaccination Officer's Report on page 86 and the corresponding
tables in previous Annual Reports, only 18 per cent, (in I932 this has
fallen to 14.3 per cent.) of children born in each year are vaccinated,
and although Smallpox contacts are offered vaccination or re-vaccination,
very few of them accept this, the only means of protection against an
attack.