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one of whom infected three of the cases which occurred in London. The seven
cases may be classified in two unassociated groups of five and two respectively, both
of which derived the infection from Paris.
Enquiries with regard to the condition of vaccination of the patients showed
that one of the cases, a male, aged fourteen years, had never been vaccinated until
five days before his rash appeared—i.e., too late to afford protection. The ages of
the other six patients ranged between 32 and 64 years, and only one had been
vaccinated since infancy-i.e., 26years before his illness, and he suffered a mild attack.
The history of the two groups of cases is as follows:—
Group I (five cases).—On the 5th September, 1926, a man (M.F.), aged
43 years, and his wife (R.F.), aged 44 years, arrived in London from South
Africa, having travelled overland, via Paris. On the 7th September they went to
an hotel in St. Marylebone. The following day (8th September) M.F. fell ill, and
he consulted a doctor on the 12th September, a rash having appeared in the meantime.
The doctor formed the opinion that he was suffering from chicken-pox. As
subsequent developments proved, M.F. was then suffering from smallpox. Between
the 8th and 12th September, when medical advice was sought, he attended the
local Jewish synagogue on two occasions, and on the 18th September, the Day of
Atonement, he was at the synagogue practically all day. It appears that after the
12th September his movements were somewhat restricted at the hotel, and, on this
account, he and his wife removed, on the 19th September, to a nursing home for
chronic cases and convalescents in Willesden, where they would have greater
freedom. Between this date and the 23rd September their movements were uncontrolled,
and they visited, among other places, theatres and restaurants in the
West End, a tourist agency (daily to collect mails), wholesale and retail firms of
various kinds, as well as private houses. On the 24th September, Mrs. R.F. fell ill
with severe pains in the back, followed by headache, vomiting and sleeplessness.
A rash appeared two days later. On the 29th September, Dr. Buchan, Medical
Officer of Health of Willesden was called in to see the case in consultation with
the medical attendant, and he found that the woman was suffering from hæmorrhagic
smallpox. Enquiries by Dr. Buchan elicited the foregoing particulars regarding the
husband's illness, and he concluded that M.F. must have been infected in Paris.
Both the man and his wife were at once removed to Kingsbury Smallpox Hospital,
where Mrs. R.F. died the same night. She had not been vaccinated since infancy.
Her husband was vaccinated in infancy and revaccinated about 1900.
Dr. Buchan forthwith informed Dr. Porter, Medical Officer of Health of St.
Marylebone, in whose district the hotel at which the patients stayed is situated,
whilst Dr. Tate, County Medical Officer of Middlesex, informed the County
Medical Officer of Health of London. The following day was spent in making
enquiries at the hotel, examining contacts and taking the necessary precautionary
measures. One of the chambermaids (I.T.), aged 32 years, was found to be ill with
a temperature, and Dr. Porter, in consultation with Dr. Wanklyn, notified the case
(30.9.26) as one of smallpox, as a precautionary measure, and had the patient
removed at once to the Metropolitan Asylums Board receiving station, North Wharf,
where subsequently an eruption appeared, which proved to be symptomatic of
smallpox. It was fortunate that this patient was removed before she became
infectious. She had not been vaccinated since childhood. It was also ascertained
the same day that a charwoman (L.W.), aged 42 years, employed at the hotel and
living in Lambeth, had been absent ill for a few days. Dr. Priestley, Medical
Officer of Health of Lambeth, was at once informed and, on visiting the woman
(30.9.26) found that she was suffering from smallpox, the rash having appeared two
days previously. She was immediately removed to North Wharf, and subsequently
to Long Reach Hospital, where the rash became confluent, and she died a week
after her admission to hospital. She had not been vaccinated since infancy.