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7
small teashop. He almost certainly had infected the five cases mentioned as they
went to and fro in their daily business. It was probable, of course, that he had
also infected other cases which had still remained undisclosed, and this in fact turned
out to be the case. During the course of the following week four more sufferers
came under notice in a different part of Stepney, viz., Mile End and the Stepney
Green area; one of these, a female hawker, had been attacked a fortnight previously
and had remained undiscovered until medical opinion was sought when her own
child, whom she infected, fell ill with smallpox. She infected two other persons
and there seems little doubt that she derived her infection from the original source
in Aldgate.
How the first case was infected, viz.. the patient who fell ill on 1st July, 1922,
remains undiscovered. It is, however, likely that infection came from the Continent;
whether by a transmigrant, or by an immigrant, or by the return of a London resident,
or by the receipt of infected articles, it is impossible to say.
Thus between 26th July and 11th August there occurred ten cases, including two
resident in West Ham and another temporarily resident in Southend, which were
due to a single unrecognised focus of infection. With the later occurrence of one
secondary case in West Ham the outbreak ceased. The fact that no more serious
developments resulted may be ascribed to the painstaking investigations and prompt
action of the public health services, both local and central. Of the eleven persons
comprising this outbreak two died.
During the period August to October three additional cases of smallpox occurred,
one, the source of whose infection remains undiscovered, on 12th September in
Bethnal Green, a male aged 17 years, who died from a severe confluent attack;
and two in Fulham, these last cases appearing in the persons of a female, aged 38
years, and her daughter, aged 12 years, who had been on a visit to Dartford, where
cases of smallpox were occurring. The mother died and the child recovered.
In October another formidable outbreak occurred, this time in Poplar, viz.,
in the Infirmary, where a case of genuine smallpox was detected upon the occurrence
of a group of secondary cases. This outbreak comprised, when first discovered
and investigated during the week-end, Saturday 27th October to Monday 29th,
no less than 25 cases either within or in the neighbourhood of the Poplar Institution.
Vigorous measures were taken and about 1,000 vaccinations effected within
the first 36 hours. In consequence the outbreak in the institution suddenly abated
as soon as the vaccinations had matured (the last case being noted about 10 days
later), and was limited to 42 cases, with 14 deaths. The unremitting vigilance and
strenuous efforts of the medical officer of health of Poplar and his staff, and those of the
local Board of Guardians, were largely responsible for keeping this outbreak in check.
As a result of this development of infection at the Poplar Institution, 12 further
cases of smallpox occurred in different parts of London, 7 at private addresses in
Poplar, including 2 fatal cases, 3 in Southwark, 1 in Lambeth (fatal), and 1 in
Bermondsey. To sum up there were altogether 65 cases in London during 1922,
including 20 which proved fatal (30.8 per cent.), distributed as follows:—
26th July—
11th August
(Stepney).—8 cases, including 1 temporarily staying m
Southend and 1 not notified. Of these 1 died. (In
addition and included in this outbreak were 3 cases in
West Ham, 1 fatal; the patient had probably taken
infection in Stepney where he worked; the other 2
recovered).
12th September (Bethnal Green).—1 fatal case. Origin undiscovered, possibly
due to indirect connection with earlier outbreak in
Stepney.
5th October (Fulham).—2 cases, 1 fatal. Both infected at Dartford.
26th October— (Poplar).—49 cases, of which 16 were fatal; 42 of these
18th December cases and 14 deaths occurred at or in connection with the
Poplar Institution.