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46
slight illness during the Christmas holiday and was diagnosed as
a case of chickenpox. The distribution of the healed lesions
however, left no doubt that her illness had been smallpox. Three
days after the removal of these patients a married sister, Mrs. R.,
another brother living at home, and his fiancee, R.A., were removed.
The following day two more sisters at home had an eruption and
were removed. Early in February further secondary infections
occurred, three in the home of Mrs. R., and one in the home of R.A.
This latter was followed at the end of the month by another case
residing in the house, and also a case occurring in a visitor.
On 20/1/31, smallpox was diagnosed in two sisters. This led
to the recognition of a missed case L.M., aged eight, who had the
rash about 25/12/30. On 3/2/31 a case was recognised in whom
the onset of the illness had been on 14/1/31, and the rash had been
out since 18/1 /81. In the same house was found a girl with a rash
which came out 18/1/31, and another girl P.M., aged eight, whose
rash came out 27/12/30. These two girls P.M. and L.M. both
attended the same school. Investigations led to finding that a
child K.B. had suffered from an unrecognised attack of smallpox,
the onset being 11/12/30. This child had apparently infected:
(1) her brother and sister at home—in both eases the disease had
been unrecognised ; (2) P.M., in whom the disease was unrecognised
—she infected her sister and her brother, and it was not until her
brother had had the rash 16 days that the illness was diagnosed;
(3) L.M., another unrecognised case who infected her two sisters;
(4) W.L., who infected his mother and brother, and in whose cases
no medical attendant had been called in. 11 cases then were
apparently due to this unrecognised smallpox occurring early in
December. There is every reason to believe that the other child
referred to above who suffered during the Christmas holidays and
led to 14 cases, was infected from the same sourcc, as she lived in
the same area and her onset was about the same date as these other
secondary infections. No direct connection could, however, be
found.
Another missed case with an onset early in February gave
rise to two secondary cases in the home at the end of the month.
Another person who was a frequent visitor to the house fell ill about
the same time and gave rise to a further four cases in her own home.
Two cases in the same house with a simultaneous onset led to the
detection of another missed case. A number of other cases gave
rise to secondaries in the home, one to four, one to three, and for
to one, and another gave rise to four in the home and to one visitor.
^Three cases were secondary to one occurring in 1930 and one to
another; and one infection was secondary to a missed case occurring
in December, 1930.