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Industrial Welfare Society, who escorted her by taxi-cab to the head office of
the Society, and from there to Victoria Station en route to Oxted and Limpsfield. It
was not until the 10th June (three days later) that a rash appeared, and smallpox
was not suspected until the 12th June, when she was removed to hospital on the
advice of the Medical Officer of Health of Godstone Rural District Council. She had
never been vaccinated. The occurrence of this case involved the following up and
vaccination of large numbers of contacts, both in and out of London; fortunately
no further cases resulted.
Apart from the cases previously mentioned as having been infected in Paris,
no case of smallpox occurred among the many passengers and members of the crew
of smallpox infected vessels who came to London. In every case these persons were
followed up by the medical officers of health concerned, and vaccination was advised
where necessary.
Provincial Smallpox.—The continuous menace to London represented by the
progressive spread of smallpox in the Midlands and Northern Counties in recent
years, which has now extended to South Wales, is a matter for brief comment, inasmuch
as, whilst this prevailing mild type of disease has now been affecting the
provinces, mainly in the mining and industrial areas, for a matter of five years, it
has not, except in one or two isolated instances, been introduced into London. How
long London will continue to escape epidemic prevalence is a matter upon which
no definite opinion can possibly be expressed, but there is no doubt that, as in
the case of the provinces, the decline in vaccination in London is a matter for serious
concern, and unless the prevalence in other parts of the country abates, it is hardly
reasonable to assume that the Metropolis will remain free indefinitely. It is, therefore,
absolutely necessary that all public health and hospital authorities, medical practitioners,
as well as the public, should be made to realise fully the menace to the public
health which exists to-day from the high proportion of the unvaccinated section of
the population.

The Council has continued to place at the disposal of medical officers of
health of the metropolitan boroughs and certain of the Home counties and extra
metropolitan authorities the services of its expert medical staff for the diagnosis of
suspected cases of smallpox.