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on 28th July, and went to Brighton from 2nd—18th August. She spent the remainder
of her holidays at. Steyning, and whilst there the case of " L. C." was discovered.
She was accordingly examined on 28th August by the county medical officer of health
of West Sussex and the medical officer of health of the combined sanitary district,
who agreed that the girl had suffered from a mild attack of smallpox, having in
view the distribution of the scars and the child's description of the history of the
rash. When examined she was quite free from infection. The source from which
she derived her attack was not discovered, but it was significant that the apartment
house in which she was living had been visited by persons from the north of England.
(5) B. P. (male, aged 24 years)—This case was notified and removed to hospital
on 29th October, 1924. The man was a valet who had been travelling in Spain with
his employer. He left Madrid where he was no doubt infected on or about 15th
October, and was taken ill on 26th October when he was staying with his employer
in a well-known West End hotel. He was taken to his home in Westminster from the
hotel on 28th October, on which day the rash was noticed, shortly after he left the
hotel. The man's employer started for America the following day, and a wireless
message was sent to the ship on which he sailed with a view to any necessary
precautions being taken. All possible preventive measures were carried out
and no further developments arose. The occurrence of this case once again illustrates
the need for guarding against the introduction of smallpox from abroad.
In addition to the aforementioned, there were four other instances in which
persons sojourning in London, en route for other destinations, were subsequently
reported as having smallpox, their onset of illness having ante-dated their departure
from London. The circumstances were as follow:—
(i.) A vessel arrived at Liverpool from Bombay on 24th April, 1924, having
had cases of smallpox on board. One of the patients (J. T.), a night watchman, was
transferred to hospital at Port Said on 11th April, and was discharged as not
suffering from smallpox on 24th April. He embarked in another vessel at Port
Said and arrived on 4th May at the Port of London. He reported at the Board
of Trade offices on 5th May, visited his brother at Canning Town on the same day
and proceeded that night to Glasgow, where he was examined on his arrival and
declared to be suffering from smallpox, there being evidence of " crusting on the
hands and head." No further developments occurred.
(ii.) On 7th May, 1924, F. S., (male, aged 53), an American subject, died in
mid-Atlantic from smallpox during the voyage from Southampton to America.
F. S. had been travelling in the East and on his return journey disembarked at
Marseilles, travelling overland, via Paris to England. He arrived at a well-known
hotel in London on 27th April, visited relatives in Essex and returned to the hotel
on 30th April feeling ill. He consulted a doctor, who diagnosed " chill on the liver,"
and on 3rd May he left the hotel for Southampton, embarking for America the
same day. He died on board a few days later. From enquiries which were made
it is unlikely that the rash had appeared before he left the hotel. No secondary
cases occurred in London.
(iii.) Mrs. W. A.—Whilst travelling in Italy in May she developed an illness
associated with diarrhoea and sickness. The onset was on 16th May, and a rash
appeared on 21st May. She was seen in Florence by three doctors (two English
and one Italian) who agreed that the rash was due to mosquito bites. She arrived
at an hotel in London on 25th May, and was seen by a doctor on 26th May, who
diagnosed her condition as being due to chickenpox, to which diagnosis he subsequently
adhered. The patient stated that she had been vaccmated three months
previously and there were good vaccination marks. On 27th May she left London
for Doncaster by car and on her arrival there her illness was diagnosed as smallpox,
and she was removed to hospital. For purposes of preventive action the diagnosis
of smallpox was acted upon in London and all precautions were taken. There were
no developments.