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which is quite distinct from the classical attack. It goes by different names
in various parts of the world. Here it is called variola minor as constrasted
with the ordinary variety variola major. About 1930 this country was
attacked by this type of smallpox. Because of the mildness of the illness
and in many cases the paucity of the lesions on the skin, many people did
not realise they were suffering from this infection. For this reason it
spread throughout the whole country and was not controlled. Some of the
more serious of recent outbreaks in this country of the ordinary variety
have been due to the atypical nature of the attack in the original patient,
almost invariably due to its having been modified by previous vaccination.
Recent vaccination is a certain preventive. In many people this protection
lasts for many years. There is no assurance though that it is effective for
more than about two years. Some protection remains even in those where
the effect wanes. This results in the person becoming susceptible and liable
to develop the attack; but there may be sufficient protection to modify
considerably the attack which might be then so atypical that diagnosis is
difficult. In such cases it is only the development of classical smallpox in
others that leads to the recognition of this atypical illness in the first
patient. When a patient who had contracted the infection say in India,
comes by boat, the disease will be manifest and all precautions could be
taken on the boat before it landed in this country. Air travel has complicated
matters because the time of travel is so much shorter than the
incubation period of the disease. A person who has been infected then
might have landed in this country and go about his business for some ten
days after landing before he falls ill. This adds immensely to the difficulties
in tracing contacts. The usual procedure is for those who might be contacts
to be kept under surveillance for some two days longer than the usual
incubation period of the infection. If they have not recently been
vaccinated, this is advised. These contacts are not excluded from carrying
on their ordinary work.
There were only two occasions this last year when this procedure had
to be put into operation. The first was in September when a person on a
cross-channel steamer was thought to be suffering from smallpox. A
number of local residents were on the boat. Later the diagnosis was not
confirmed. The other case was a Pakistani who arrived in this country on
25th December. His rash came out on 27th December and he was removed
to hospital on 28th December. There was one local contact, a nurse at the
hospital he first attended.
Vaccination. During the year, 2,391 persons living in the district
were vaccinated against smallpox for the first time. Of these, 1,553 were
under one year of age and 397 were over one but under two years of age
620 persons were re-vaccinated. 3,085 babies were born during the year.
The number of vaccinations of those under one year of age was therefore
50% of the births. Of those under one year of age who were vaccinated
630 were treated at the infant welfare centres.