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disease is not infectious in any ordinary meaning that can be
given to the word. There is no evidence to show that the infection
is spread from case to case, and multiple cases in the
same house or same family are very rare. Its history in this, and
other countries shows that it occurs in epidemics, and it is difficult
to conceive a disease as an epidemic that is not at some stage
spread from person to person. Carriers have been suggested
but their existence has never been proved.
Small-Pox.
During the year 7 cases of Small-Pox were notified. All the
cases were of the mild type which has been prevalent in and
around London during the past few years. Although the cases
have been similar to each other clinically, from an infectious point
of view there has been a considerable difference. In this respect
it resembles the virulent type of disease, the so-called Eastern or
Asiatic Small-Pox. In most epidemics of the virulent type of
Small-Pox there are instances in which the disease is intensely
infectious, whilst at other times the disease seems hardly
at all infectious. Presumably the same strain of germ
or virus is present at both periods, but at one time the
infectivity seems to be much greater than at another time. The
same phenomenon has been noticed in the present epidemic. The
number of admissions to the Metropolitan Small-Pox hospital
in 1929 was 3,031, made up mainly of the mild "native" type,
but including some of the Tuscanian group. There were 10
deaths, one in a patient who had not had Small-Pox; two and
possibly three of the Tuscanian cases; two premature infants,
towards whose deaths Small-Pox may have contributed a little;
two cases in which it may have had more say and two of confluent
Small-Pox who died from septic absorption following maturation.
These figures suggest that there was no change in the type of
the disease. I believe that the same phenomenon has been
observed in 1930. The type has been mild and there has been
no tendency to enhanced virulence in the cases. All the cases
which occurred here were of the same mild character. The first
occurred at East Acton, and was notified on June 17th. The
patient was a bus conductor, but he had been confined to the
house from the time the rash appeared until his removal to
Hospital. The contacts were easily traced and they all consented
to be vaccinated or re-vaccinated. The children in the house had
not been previously vaccinated. No further cases occurred as a
result of infection from this patient. The case was a simple one,
the contacts were easily traced and re-vaccinated and control was
not difficult.
The next instance was of an entirely different character.
Two cases were notified from Ramsey Road,— one on June 28th
and the other on July 1st. These were two brothers, and on
enquiry, it was found that another brother had been ill about three