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51
One patient, aged 21 years, and successfully vaccinated in
infancy, was notified as suffering from Chicken Pox. Onset was on
the 8th April, the rash appeared on the 10th, and she was removed
to Hospital with a tentative diagnosis of Smallpox on the 11th and
revaccinated as a precautionary measure on the same day. Although
the revaccination was successful the case was counted as one of
Smallpox.
Eight cases were sent into Hospital during their prodromal
illness, i.e., before the appearance of the rash, which appeared in
due course. In this way dissemmination of infection in the home
was reduced to an absolute minimum.
The number of contacts notified by other Authorities was 134
as compared with 1,175 during 1930—a very welcome decrease.
The following Authorities sent notifications of contact in respect
of Walthamstow residents employed in their areas:—City of
London, 12; Borough of: Hackney, 10; West Ham, 8; Shoreditch, 8;
Finsbury, 8; Poplar, 4; Stepney, 2; Leyton, 2; Bethnal Green,
Southend-on-Sea, Holborn, Ilford, Chelsea, Islington and Chelmsford,
1 each: Loughton U.D.C., 1; and Merton and Morden
U.D.C., 1.
The series of 67 cases represented 46 households with 63 families
and 299 "home" contacts. Multiple cases occurred in 10 of these
households thus:—6 cases (once), 5 cases (twice), 4 cases (once),
2 cases (in 6 households). In 11 of these cases vaccination had been
performed (and successfully in 9), but not sufficiently early to prevent
the development of Smallpox. The earliest date at which these
vaccinations had been done was 8 days before the onset of symptoms
(3 cases), so that it is fair—assuming the average incubation period
to be 12 days—to claim that successful vaccination within 3 days
of the initial exposure to infection protected these contacts.
From a perusal of the case papers the most infectious period
appeared to be the day of the appearance of the rash and only 2 cases
appeared to have been infected on the day preceding the rash. No
evidence was found pointing to infectivity before this period.
The general scheme of control was detailed in the 1930 report.
Unfortunately, some of the confidential information contained in
the circulars sent to other areas was misused with the result that
not only were many contacts (living in Walthamstow but working
elsewhere) suspended from work without pay, but some were
dismissed.
Frequently contacts are aware of the risk attending the disclosure
of the nature and place of their employment, and in one
case information as to contact was deliberately withheld with the
result that Smallpox was carried into an adjoining area. This case