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family showed four cases of Smallpox, two in an advanced
stage of rash, one severe, and one with mild early stage of
rash. This family was able to inform me of another family
in Devonshire Place with a similar rash, which on visit
was found to have three cases of well developed Smallpox.
No further cases were discovered that day, but we were fortunate
in discovering a source of infection and being able
to isolate 13 cases of Smallpox in the first day of the search,
but it was obvious that the infection must have been widely
spread, and it was only after some three months that we
were able to clear the Borough of the infection.
Type of Infection.
The type of infection in all cases was "mild Smallpox,"
one case being mildly toxic, six cases had a severe
degree of discrete rash and one being confluent.
There were no deaths and no complications.
As is usual with this type of Smallpox, a case with
a few " "spots" frequently gave rise to cases with severe
discrete rash. The initial symptoms of onset were in most
cases sufficiently severe to put the patient to bed, but in
some cases the initial symptoms were no more severe than
a passing "cold." The severity of onset of symptoms
was no indication of the severity of the rash to come. In
all but one case the rash was typical, but one met with
the usual difficulties of diagnosis in this type of Smallpox.
Infeetivity.
For some reason certain cases spread the infection
wherever they go, whereas other cases equally severe, in the
same stage of rash and with similar chances of spreading
infection, result in no secondary case. Thus case 5 of the
epidemic was known to have heen the direct cause of 11
other cases, yet other cases similarly affected did not spread
their infection.
Two cases known to have been in attendance at school
throughout their infectious period gave rise to 15 cases in
that school. One case attended another school in an active
stage of infection, and yet only two other cases arose from
it. Another case of a school child attending another school.