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8
The history of the outbreak is briefly as follows: —A commercial traveller
(A.M.), aged forty-seven years (vaccinated in infancy), living in Golders Green,
who represented a firm of coal merchants in Paddington, and whose business
necessitated frequent calls in the East end, fell ill on the 25th March, 1927, and
four days later deve'oped a rash which was considered to be that of chickenpox.
Subsequently, his wife (vaccinated in infancy) and daughter (aged sixteen years,
unvaccinated) fell ill and developed rashes on the 9th April and the 13th April
respectively; they were both admitted to a Hampstead nursing home under the
impression that the disease from which they were suffering was chickenpox.
Suspicion of smallpox was not entertained until 23rd April, when the Medical Officer
of Health of Hampstead was called in, with the result that both patients were
diagnosed as suffering from confluent smallpox. The daughter died in the Metropolitan
Asylums Board Smallpox Hospital, Long Reach, Dartford, to which both
patients had been removed. Further examination of A.M. revealed that he had
had smallpox, and that he had not completely recovered. Another unvaccinated
daughter, aged eight years, was also found to be suffering from the disease. They
were both removed on the 24th April to the Middlesex County Council Smallpox
Hospital at Yeading. As a result of the discovery of these cases four others were
detected among the workers at the laundry to which the linen of the aforementioned
family had been sent to be washed ; their rashes having appeared on the 21st
April (two cases), 26th and 27th April respectively. A baby of one of these patients,
prematurely born during the early stage of illness of the mother, also developed a
smallpox rash (4th May) seven days after birth. Only one of the laundry workers
who developed smallpox had been vaccinated and then only in infancy. Four
cases connected with the laundry workers proved fatal, including the baby and its
mother.
The five cases, described below, occurred in London whilst the Hendon outbreak
was in progress, and in the absence of the discovery of definite sources of infection,
could only be regarded as having originated directly or indirectly with the Hendon
cases or with some other missed case or cases which gave rise to or was associated
with that outbreak.
(1) A.N., a female, aged forty years, stated to have been vaccinated although
no scars were discernible, was the daughter of the proprietress of an apartment
house in Hampstead in close proximity to the nursing home where two of the
Hendon cases were treated before they were recognised as smallpox {vide supra).
Her rash appeared on the 5th May, but the case was not discovered until the 7th
May, when she was removed to hospital. She died four days later. Although no
direct association could be established it may be assumed that her infection was
derived in some way from the nursing home.
(2) On 10th May, C.R.. a male, aged twenty-nine years, unvaccinated, living
in Poplar, was found to be suffering from smallpox, the rash having appeared on
the 7th May. He had been moving about freely up to the time the nature of his
illness was discovered, but the fact that no secondary cases resulted was no doubt
largely due to the prompt action of the Medical Officer of Health of Poplar, who
arranged for about two hundred and seventy persons to be vaccinated in connection
with the occurrence of this case. The patient recovered after having had a severe
attack. The source of infection was not elucidated, but it was significant that the
man was infected during the time the Hendon cases were occurring.
(3) C.S., aged twenty-nine years, living in Hackney, brother-in-law to C.R.,
mentioned above, was removed to hospital on the 19th May whilst he was under
observation as a contact. The rash did not appear until the day following his
removal to hospital, i.e., probably before he was infectious. He was primarily
vaccinated on the 10th May as a contact of C.R., and his illness was modified in
consequence.