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18 Report of the Medical Officer of Health.
on the body, no importance was attached to them. These
unrecognised cases were an important factor in spreading the
outbreak, and several groups of cases emanated from persons
who had suffered from the disease, without knowing it, several
weeks previously.
Many of the cases were seen in consultation with the late
Dr. W. M. Wanklyn, of the Medical Staff of the London
County Council, whose extensive experience in the diagnosis
of Small-pox was of great assistance to me throughout the
epidemic, and I wish to acknowledge my indebtedness to him.
I would also like to thank Dr. J. A. H. Brincker who saw
several of the cases with me in Dr. Wanklyn's absence.
The condition of the 88 patients in regard to vaccination
is instructive and shows the value of recent vaccination in
preventing Small-pox.
Seventy of the 88 cases, i.e., 80 per cent, occurred in
persons who had never been vaccinated at the time of infection.
Sixty-six, or 75 per ceni. of the patients were under the
age of 25, and none of these had ever been vaccinated.
None of the 18 vaccinated persons had been donev since
infancy, and the youngest was 28 3 ears of age.
One of the cases was a man who was removed from the
Wandsworth Casual Ward on the 8th June. He was infected
in the Marylebone Hospital where cases had occurred at a
time when he was an inmate. This case was a sporadic one,
infected elsewhere, and was not connected with any of the
other 87 cases.
The outbreak started in the Springfield Mental Hospital,
which is the Asylum for the County of Middlesex.
The infection appears to have been introduced into the
Institution from one of the districts round London from which
the Hospital draws its inmates, as cases of Small-pox had
occurred in these districts.