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6
Infections Diseases.
Smallpox. Smallpox in 1922 presents a record of remarkable interest in several noteworthy
particulars, among which are the following. London was entirely free from smallpox
for six consecutive months, namely, from January to June inclusive. During the
second six months, July to December, there were sixty-five cases, including two
which were not notified and one which was notified in Southend, where the patient
was temporarily residing at the onset of illness; this is the highest number but
one occurring in any one year since 1904; of these sixty-five cases no fewer than
twenty were fatal, the mortality thus being 30.8 per cent.; the majority of these
cases and deaths, and possibly all of them, were primarily due to the real nature
of the illness having been overlooked. Two other points also are remarkable:
one, that most of the cases occurred in a public institution, in which vaccination
had fallen into abeyance; the other, that whereas London, as noted, was attacked
by a severe form of smallpox, which probably was derived from the continent, it
was not invaded by the mild smallpox which has been prevalent in the North
and Midlands for about two years. It should be noted that this outbreak is still
progressing there, and that during the early weeks of June, 1923, the disease
was found to be rather extensively prevalent in Gloucester. London continually
stands, therefore, under the risk of being invaded by this mild form of smallpox
(which, nevertheless, is apt to be very costly to business and commerce), as well as by
the more severe type from abroad.
The occurrences of smallpox in London during the last six months of 1922 consisted
in the main of two distinct outbreaks, one in Stepney during July and August,
and the other in Poplar during October and November, with a few "off-shoots"
in other boroughs.
The outbreak in Stepney may be briefly described as follows. On Tuesday,
26th July, 1922, the medical officer of health of St. Pancras caused to be removed
to hospital a case of smallpox which had commenced on 22nd July and at first was
taken for scarlet fever. Southampton was thought at first to have been the origin
of infection, but the real source was only disclosed subsequently by the evidence
adduced at certain out-County consultations. On Saturday, 29th July, Dr.
Wanklyn was called into consultation at West Ham, and there pronounced a
suspected case to be smallpox. On Sunday, 30th July, he was called into
consultation at Southend and diagnosed a suspected case there to be suffering from
smallpox. Though the respective homes of these three patients were wide
apart and apparently had no connection whatever, as a matter of fact they did
form one group. A careful note of all their circumstances was made and juxtaposed
for comparison and deduction. When this was done it seemed possible that a certain
ladies' apparel warehouse in the City was the infecting centre. Further enquiry
and analysis, however, aided by the evidence disclosed on the supervention of the
fourth case in West Ham on 30th July, revealed the fact that, beside their dates,
these four cases had one feature only in common, namely, the junction of their
respective daily business journeys. The first patient was a hawker, the second
a seamstress, the third a tailor's apprentice, and the fourth a blacksmith; their
stories showed that, unknown to each other, they had daily met about one point
in London, namely, Aldgate East, and the only possible hypothesis appeared to
be that about this point a person hitherto undiscovered had unknowingly infected
them. The most likely locality to be inhabited by this person was circulated to
the officers concerned; further inquiries were pressed locally, and the alertness
of the Stepney medical officer of health led to the discovery of the original focus
of the mischief in the area which had been specified. There were thus brought to
light two other cases, the fifth and sixth in chronological discovery, but the first
and second in actual occurrence. The first, it was then found, had fallen ill on 1st
July, and on 4th July had sought medical advice ; being told he had chickenpox,
he had gone about much as usual, pursuing his occupation as a shop assistant in a