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borough medical officers of health and the Council's consultants are always available
when required.
It w'll be of interest to sketch briefly the particulars of the five cases, including
one " missed case," among London residents during the year, and of certain other
cases, which though not occurring in the metropolitan area, came within the purview
of the health administration of the County.
(1) J. F. (male, aged 54 years)—A resident of Kensington was notified to be
suffering from smallpox on the 30th June, 1924. This patient was associated
with a group of cases, three of which were fatal, in an extra metropolitan district
just over the county boundary; all of them were infected by a missed case. The
original case was that of a male child, aged three years, who developed a rash about
the 12th June, 1924, diagnosed by the doctor in attendance as chickenpox. On
25th June the medical officer of health called in one of the Council's smallpox consultants,
as several members of the family and other occupants of the house had
fallen ill. Although the illness had not developed sufficiently to warrant a diagnosis
that day, the consultant saw the patients again the following day, in addition to
two others who had fallen ill, and advised their removal to hospital as genuine cases
of smallpox. They included four males, aged 39, 14, 7 and 3 years respectively, and
four females, aged 34, 17, 10 and 5 years respectively ; one of them was the original
child, aged three years, who had actually recovered from the illness though the
scars of smallpox remained.
A further case developed the succeeding day (27th June), and on 1st July
the remaining member of the two families of 10 persons, living in the house, of whom
five were unvaccinated, had developed smallpox and three of them, including a
haemorrhagic case, died. J. F., the Kensington resident already mentioned, collected
the rents from the infected house, and, in common with the other cases, was infected
by the child whose attack was originally mistaken for chickenpox. This outbreak
illustrates the point that a mild unrecognised case of smallpox can, and frequently
does, give rise to secondary cases of a virulent type. Exhaustive enquiries were
made as to the origin of infection, but no satisfactory explanation was forthcoming,
although a number of clues were closely followed up. A large number of vaccinations
were carried out in the neighbourhood, including all possible contacts (both direct
and indirect) and 112 children at the Council school, where one of the patients
was in attendance.
(2) II. B. (female, aged 73 years)—Was notified and removed to hospital suffering
from smallpox. The patient went to Brighton for a holiday from 19th July to 2nd
August, 1924, when she returned to her home in Fulham. On 9th August she went
to stay with her sister in Chelsea, as she had been feeling unwell, and on that day a
rash appeared on her face. On 12th August she was seen by the acting medical
officer of health and one of the Council's smallpox consultants, who pronounced the
case to be one of smallpox in a mild form. The patient had not been vaccinated since
infancy. The infection must have been contracted whilst the patient was on holiday,
but after the fullest enquiry nothing definite could be ascertained. All precautions
were taken and no further developments arose.
(3) and (4) L. C. (female, aged 54 years)—A resident of St. Pancras, was notified
as a case of smallpox on 26th August, 1924, after examination by one of the Council's
consultants. The patient was taken ill in church on Sunday, 10th August, and went
home to bed. The rash appeared two or three days later, but smallpox was not
suspected by the medical attendant until 26th August. All precautions were
taken and the contacts vaccinated. During enquiry into this case it was discovered
that an unvaccinated schoolgirl, H. S. (aged 15 years), had suffered from what was considered
to be an attack of chickenpox about five-six weeks previously. This girl
stayed away from school early in July suffering from headache, giddiness and
feverishness ; on 5th July she had a few spots on the wrists and ankles and was seen
by a doctor who diagnosed her illness as chickenpox. She resumed school attendance