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62
Appendix A,
NOTES on an Epidemic of Small-pox, by the Medical Officer in charge of
Denton Hospital, 1915.
VARIOLA SINE ERUPTIONE.
The epidemic of Small-pox here recorded, derives a special interest from what
appears to me to be clear evidence of Small-pox without eruption, in two of the cases.
Clear evidence in such cases must of necessity be very much rarer than occurrence
of the cases. Osier, in 1897 wrote, " I do not remember to have met with an instance
of this kind or to have heard of one " ; yet on analogy with every exanthematous
disease such cases should be by no means rare in times of epidemic Small-pox.
The facts are as follows : a party of ten persons, five vaccinated and five
unvaccinated, boarded a homeward-bound vessel at Port Said.
C.L., male, aged ten years, was taken ill, and the rash of Small-pox appeared on
January 28th. The ship's surgeon was called to see the boy on January 31st. The
party of ten persons was segregated from the passengers and crew on February 1st.
The case was landed into the Port of London Isolation Hospital on February 7th, where
the remainder of the ten were content to remain and await the developments of which
they were warned.
Rash appeared in succession on the remaining four unvaccinated children on the
11th, 13th, 14th and 15th February. These children were all under eight years of age.
Two of the ship's company showed the first sign of rash on the 12th and 13th
February respectively, and were forthwith removed to the hospital.
On February 10th a well-vaccinated girl of the party, aged 13, was found to have
fever, slight headache, and want of appetite. The temperature became normal on
February 13th—no eruption appeared.
On February 11th the father, aged 40, poorly vaccinated and just as poorly
revaccinated twenty years ago, felt dizzy, and was found to have fever : his symptoms
were fever, nausea, and severe backache. The onset was quite sudden. His temperature
became normal on February 14th, and no eruption appeared.
There are thus two cases of fever to be added to the former six, occurring contemporaneously
with these, of duration equal to the usual invasion period, and presenting
pre-eruptive symptoms of Small-pox, the one vaguely, the other markedly. These two
persons, father and daughter, shared the nursing of the first case on the ship and
constitute the cases which are presented as Variola Sine Eruptione.