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Contacts.—In addition to the contacts arising from the cases
reported in this Borough, a large number of contacts was also
received from other districts, including the Port Medical
Authorities of London, Southampton and Liverpool. All these
persons were kept under observation for a period of 18 days, and
the number of visits made by the Sanitary Inspectors to these
persons during the year totalled 13,994.
General Review.—The incubation period of this type of smallpox
is usually 14 days, but several cases have come to my notice
where the incubation period has extended to 16—18 days, and in
one or two instances as long as 20 days.
The disease is usually ushered in by a sharp sudden illness
characterised by headache, pain in the back and limbs, and a
provisional diagnosis of influenza is common.
The similarity in the early symptoms of the disease with
those of influenza was brought to the attention of every general
practitioner in the Borough in the early months of the year, and
at the same time I took the opportunity of stating that I should
be pleased to offer my services in consultation in any doubtful
case.
Owing to the anomalous character of the disease the diagnosis
of cases of this type of smallpox is frequently extremely difficult
and is often a source of considerable anxiety.
Any test, therefore, which could be used to assist in the
diagnosis would be of inestimable value. In this connection the
results of the experimental use of an anti-vaccinia serum for the
purpose of the differentiation of smallpox crusts from the crusts
of severe cases of chickenpox gives promise that such a test may
be available in the near future for the diagnosis of smallpox.
Smallpox, whether it be severe or mild in character is disturbing
to the community and is extremely costly in money.