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49
another six. It is probable that removal to hospital of the primary case
in none of these instances would have prevented the second case succumbing.
The position is different though in the remaining instance in which
the primary case was nursed at home and there was an interval of 19 days
before the onset of illness of the secondary case. There was one instance
of simultaneous onset of two sisters.
There were no return cases this year.
Each year groupings of cases occur amongst the pupils of a school,
sometimes in the same department and occasionally even in the same class.
So very often enquiries fail to lead to the recognition of one who might
be a carrier, and in due course the cases cease to occur. In the spring term
10 cases occured over a period of six weeks amongst the pupils of Harrow
Weald School. In the autumn term five cases occurred amongst the
pupils of Roxeth Manor Infants' School; after a period of three weeks
clear of cases another case occurred in that department, followed after
another clear week by another case. The occurrence of three cases in
one week in the pupils of Chantry Junior School was followed in the next
week by one in the infants' department, and in the following week each
department had one case.
SMALLPOX
There are for most of the time no cases of smallpox in this country.
Occasionally there are outbreaks which can be explained only by the
spread from a case infected by some inanimate object. Most importations,
however, are from unrecognised cases which come into the country from
places abroad. Before the days of the aeroplane and because the countries
in which the infection had been contracted were many days sailing away,
the patient would be recognised to be suffering before he landed. Today
the situation is different as air travel can result in a person who has entered
the country being only in the earliest days of incubating the disease.
There is then the ever present risk of the introduction of a case into the
country. The extent to which this might spread depends almost entirely
on the degree to which those who have been in contact with him are liable
to contract the infection. This in its turn means the degree to which they
are protected by vaccination carried out recently, or remotely. Although
at one time it was held that vaccination carried out within a few days of
exposure to infection would protect the contact against an attack, this is
not the position today. Admittedly early vaccination after exposure will
greatly reduce the risk and in most may avert an attack, but not necessarily
in all. There is the further danger that the modified attack in a person
Partially protected may be so atypical that it is not recognised in the early
page, and by the time it has been recognised the contact will have been so
long exposed that at that stage vaccination can do nothing to influence
the development of the disease. The only measures which can give
protection against the growing risk to which everyone is liable to be
exposed is vaccination; and because the effects of vaccination are liable
to wane, re-vaccination is desirable on at least one occasion other than
the Protection given in infancy.
The position about vaccination in the country as a whole is not
satisfactory as only about one third of the infants are being vaccinated.
In this district the position is rather more satisfactory. In 1955 1,930
D