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18
homes. For this purpose the deputy medical officer of health
(Dr. Epsom) organised three parties comprising doctor, health
visitor and public health inspector to carry out house-to-house
vaccination of all contacts. Concurrently the deputy area medical
officer(Dr A. Yarrow) and area chief clerk (Mr. Relleen) opened an
emergency vaccination centre at Chestnuts, St. Ann's Road which
was continuously staffed over the week-end and for as long as
necessary thereafter.
Hyperimmune gamma globulin
Since doubts were felt about the effectiveness of vaccination,
so late after contact with the primary case it was decided to reenforce
vaccination with anti-variola gamma globulin. Application
was at once made to the Ministry of Health and half the available
stock was released. This amount was divided equally between the
hospital and public health departments A dose of 10 ml (1,000
mgms.) for an adult and 5 ml (500 mgms) for a child was given to
the previously unprotected primary contacts. in practice it was
found that much patience was required in preparing the injection.
The protein proved extremely difficult to get into solution or
suspension and each dose took approximately 10-15 minutes to
prepare.
Origin of the infection
A report of smallpox, in midsummer, and in a patient with no
known history of recent arrival from or links with, those parts of
the world in which smallpox is endemic must immediately arouse two
considerations in the minds of those in the central government
department who are concerned with smallpox. The first, that
there has been a misdiagnosis, for smallpox in this country is
nearly always imported during our winter. The second, that if the
diagnosis proves correct, the disease must, have been present in
the country, unsuspected, for some little time, and that evidence
of this can be found if search is made in the right quarter.
In the incident now related, examination of the patient M.B.
had left no doubt as to the diagnosis.
It was a matter of general knowledge that no case of smallpox
had been notified for some three years and within the personal
knowledge of one of us that there had been no recent suspicion of
this disease. It was quickly established that there was no link
or association between the patients, M.B. and Mrs. A. and any
foreign country. Few could have led a more circumscribed existence
than the widowed grandmother, and the boy M.B.s small world did