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16
X left Valencia for England on 4th August. Smallpox had been more or less pre.'
valent in Valencia, and apparently X had been infected about three days before
she left Valencia. Arriving at Dover on 7th August she came direct to London,
proceeding to an hotel in the vicinity of the railway terminus, where she stayed
for two nights. She left this hotel on 9th August for the hotel in central London
already referred to. She visited Brighton on 11th August and returned to her
London hotel on 13th August, when, as stated above, she kept to her bed until
19th August. She is said to have remained in her own room at the hotel during
this period, in which she infected two hotel employees mentioned above. She
left the hotel on 19th August for the address at which she was found in the out.
county suburb, and was seen on her arrival at that address by a local doctor who
diagnosed her complaint as chickenpox. For the next few days she is said to have
stayed indoors, but during this period, either on her journey from the central London
hotel or subsequently, she infected her relative already referred to, and probably,
also, 4 other persons. During the later period of her convalescence, before she
was removed to hospital on 10th September, she was going about as usual, visiting,
shopping, etc. The shops she visited were ascertained as far as possible, and all
precautionary measures in the matter of observation and vaccination of known
contacts, including the employees at the shops, were taken.
After the removal of X to hospital 10 further cases occurred, 5 of which were
notified in London and 5 in extra.metropolitan districts. Three of these persons
were infected by the case referred to above, in which a visit to Oxfordshire had
been made a fortnight before illness developed. Four other cases were infected or
presumed to have been infected, by one of the earliest cases, viz., that of the patient
employed in the vicinity of the hotel in which X had stayed. Of the remaining
three cases, one was a man, employed by a laundry firm in washing soiled linen
from the hotel where X had stayed, and the other two were adults who had occupied
at different times the room at the hotel in London occupied a few days previously
by X.
The medical officers of health of the various metropolitan boroughs and certain
contiguous areas around London had the assistance of the Council's experts in
diagnosis, Dr. W. McConnel Wanklyn and Dr. J. A. H. Brincker, and took prompt
measures to arrest spread of the disease, including the vaccination and observation
of contacts. Vaccinations and re.vaccinations by public vaccinators of school
children in the schools directly or indirectly connected with the outbreak were also
carried out through the medium of the Council's divisional medical officers acting
in co.operation with the boards of guardians. Only one child of school age (an
unvaccinated boy of 12 years) contracted the disease.
Of the 18 cases which occurred, 12 patients whose ages ranged between 23 and
79 years had not been vaccinated since infancy, and of these one died; 5 between
the ages of 12 and 50 years were unvaccinated, and of these one died. One
patient had been vaccinated nine years previously, and suffered a very mild
attack.
No other cases of smallpox occurred in London during 1923. It will be of
interest, however, to record the occurrence of a case of smallpox in one of the northern
suburbs outside the county area, as another instance of the introduction of the
disease into this country from Spain. The patient, an Englishman employed at
Tortilla, Spain, arrived in London on 7th December, 1923, having travelled via
Paris, Calais, and Dover. The nature of his illness was not decided until 11th
December, when Dr. Wanklyn was consulted as to the diagnosis at the request of
Dr. Tate, County Medical Officer of Middlesex. It was found that the man was
suffering from smallpox, his rash having first appeared, as far as could be ascertained,
in Paris, on the 6th. Immediate steps were taken in co.operation with Dr. Tate,
to follow up the contacts both in and out of London, and fortunately no developments
occurred. The occurrence of this case, however, further emphasised the