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the Metropolitan Asylums Board, the City Corporation, the Port of London Authority,
metropolitan borough councils, boards of guardians and sanitary authorities generally
in the greater London area. The menace of smallpox is officially realised to
the fullest extent, and so far administrative action has been succesrful in stamping
out infection before it can obtain a foothold. The medical practitioners appreciate
the importance of the subject and are kept aware, as far as possible, of the facilities
which exist for securing a consultation in the diagnosis of suspected cases. " To
be forewarned is to be forearmed," and this truth has no greater significance than
in its application to the control of smallpox. The foregoing observations are well
illustrated in the following description of a limited outbreak of smallpox in and
around London which commenced in August, 1923. A lady who had just come from
Spain fell ill with smallpox in a London hotel, became convalescent, and went about
shopping before the true nature of her disease was recognised ; 24 days elapsed
between the time when she became infectious and the time when her case was recognised
and preventive measures could be initiated. Infection from her attack (which
was of the malign type) thus had a long start and in point of fact planted 14 separate
foci, 8 in London and 6 in neighbouring out.county districts. The fact that
secondary cases arose in only two of these districts is eloquent of the suppressive
measures adopted, and reflects credit on all the districts concerned. As a result this
outbreak was brought completely to an end in just over two weeks from date when
the first case became known. Details are as follows.
Attention was first directed to the appearance of smallpox in London on 7th
September, 1923, when the medical officer of health of a south London metropolitan
borough discovered a case of smallpox. This patient, a girl, was employed as a
chambermaid at an hotel in central London, and although more or less delirious
when examined, she was able to furnish sufficient information to provide the clue
as to the source of infection. During the course of her duties at the hotel she had
waited upon a visitor from Spain (a woman, referred to in this report as X), who
was ill in bed during the period 13th to 19th August with what was thought, without
medical advice, to be influenza with spots, or the result of fish poisoning.
It was ascertained that X left the hotel on 19th August, and steps were immediately
taken to trace her movements and destination.
Later, on 7th September, attention was drawn to two further suspicious cases
which were found to be smallpox. In one case the patient had been to Wales on
business, but the period elapsing between the date of his return to London and that
of the onset of his illness negatived the suggestion that infection might have been
contracted during his visit to Wales. The other patient was employed in the
vicinity of the hotel where X had stayed.
On the following day two additional cases of smallpox were diagnosed in
London. One of these patients was employed at the hotel in central London where
X had stayed. The other patient had travelled, about a fortnight prior to her
illness, to Oxfordshire, where, as far as records showed, no case of smallpox had
occurred.
On 10th September it was ascertained that X had gone to an address in an
out.county suburb. The local medical officer of health, on visiting at that address,
discovered an adult, a relative of X, suffering from a severe attack of smallpox,
and ascertained that X was out shopping in the west end of London. On her
return she was found to be recovering from a mild attack of smallpox.
On the same day (10th September) another case of smallpox was discovered
in London. The patient was a relative of X and had been in contact with her.
Thus between 7th and 10th September, in widely separated districts, 8 cases
of smallpox had been discovered, of which 6 were presumably associated directly
or indirectly with a common source of infection, namely, X, whose movements
from the time of leaving Spain to the time of admission to hospital afford a striking
example of the risk of smallpox being introduced into this country from abroad.
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