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83
of their last known contact or possible contact, a length of time which
covers the incubation period. In April a number of passengers arrived
in England in an aeroplane on which they had been in contact with a
person who was later discovered to be suffering from smallpox; one of
these passengers came to an address in this district. This district was
only slightly involved in the incident which affected a number of districts
in Greater London in the summer. Towards the end of June, a boy
admitted to a hospital in Tottenham was recognised to be suffering from
smallpox. He had apparently been infected by his grandmother and in
turn probably infected his aunt. This district was involved at that time
only because one of the staff at that hospital in Tottenham was a person
who lived here, and who came home for a short time a few days after
the illness of the boy was diagnosed. The infection in the grandmother
was probably associated with an unrecognised case of smallpox in a man
who lived in Wembley. He had been infected while on a visit to West
Africa and in turn infected his daughter and also his brother. The original
case was atypical, probably because the effect of the vaccination carried
out in infancy had waned sufficiently to permit an infection, but was
nevertheless present in sufficient strength to modify the attack which was
therefore atypical. The virus was sufficiently virulent to cause the deaths
of two patients. This incident once more points to the desirability of all
being vaccinated against smallpox, and for those who are likely to be
especially exposed to infection to be re-vaccinated.
Vaccination. The arrangements for the vaccination of the general
population under the Vaccination Acts came to an end when the National
Health Service Act came into force. Since then there has been no
Vaccination Officer with a duty to see that infants are vaccinated by the
time they are six months old unless their parents had obtained an
exemption to this being done. In spite of there being this legal obligation,
so many were exempted that in general only about one child in three was
being treated. From 1948 the arrangements for vaccination against
smallpox have been the same as those by which children are inoculated
against diphtheria by the general medical practitioners. Whereas, however,
there was a high acceptance rate for inoculation against diphtheria,
only about the same proportion as before were being protected against
smallpox. When the County Council agreed to arrangements being made
by which those infants who attend the infant welfare centres might be
vaccinated at the clinics, there was a marked rise in the numbers treated.
During the year 2,578 persons living in the district were vaccinated
against smallpox for the first time. Of these, 1,709 were under one year
of age, and 185 were over one but under two years of age; 1,214 persons
re-vaccinated. 2,853 babies were born in that year. The number of
vaccinations of those under one year of age was therefore sixty per cent.
the births. Of those under one year of age who were vaccinated, 768
were treated at the infant welfare centres.
Anyone in this country might contract smallpox either by his being
a contact of a case which has been contracted abroad, or secondary to
contact case, or by him himself being affected whilst abroad. What
might happen here, then, depends so very much on what happens abroad,
especially in those countries where smallpox is still prevalent. To control