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14
Ramsay and a medical officer from the Ministry (CGN) had
arrived at the hospital and agreed to the clinical diagnosis of
smallpox Arrangements were made for the immediate transfer of
the patient to Long Reach Hospital, Dartford, under the care of
the late Dr M, Mitman During the same day a preliminary report
was received from the Director of the Virus Reference Laboratory
(Dr PO Maccallum) that the complement fixation test was strongly
positive for variola-vaccinia Subsequently, on the 5th July,
the boy died Throughout his stay at St Ann's Hospital he had
been barrier-nursed in single cubicles - for the first four hours
in the poliomyelitis unit and for the remainder of the time in
another cubicle block
Before the clinical diagnosis had been confirmed the parents
of the patient had been interviewed by the chief public health
inspector (Mr E,T, Jenkins) and detailed information of the
members of the household and their occupations obtained The
father, employed by the London Transport Executive as a bus conductor,
had reported at his depot early that morning; and as an
obvious risk the medical officer of health at once spoke on the
telephone to the chief medical officer of the London Transport
Executive
This early inquiry into the home circumstances revealed a
further case of' smallpox the boy s grandmother (Mrs A) living
in the same house and by this time convalescent This patient,
vaccinated in childhood and now aged 61» had fallen ill on the 8th
June and developed a rash (which was considered by her medical
attendant to be chickenpox) on the 12th June She was seen by
two of the present writers (GHH and CGN) in consultation
with Dr Ramsay, The clinical findings were equivocal but consistent
with a modified attack of smallpox In view of the
satisfactory vaccinal state of the rest of the household, now
refreshed by further vaccination, it was considered justifiable to
await the result of laboratory examination of scrapings taken from
the most suitable of the few remaining lesions To complete this
patient's subsequent history, the complement fixation test was
reported as positive on the following day, when she was removed to
Long Reach Hospital, and a positive egg culture was reported as
further confirmation two days later This patient continued an
uninterrupted convalescence and was in due course discharged from
hospital Prom the chief public health inspector's inquiries, it
was learned that the patient was employed as a domestic worker in
the pathological laboratory at another hospital in the Tottenham