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If the cases among persons whose vaccination is reported by the Metropolitan Asylums Board
as "doubtful" be included with the vaccinated, the following rates are obtained:—

It will be seen, therefore, from these tables that among unvaccinated children aged 5-7 years the
small-pox case rate was 29 times greater than that among vaccinated children of the same age. Among
children 7-10 years the unvaccinated case rate was 17 times greater than that among vaccinated children
at the same age, and at the age 10-13 years the unvaccinated case rate was 11 times greater than that
among vaccinated children of the same age. If the "doubtful" cases be included among the vaccinated
the relative figures are as follows:—Age 5-7 years the case rate among the unvaccinated children was
21 times greater than that among the vaccinated at the same age; age 7-10 years 14 times greater;
and at the age 10-13 years 9 times greater than that among vaccinated children at the same age. The
corresponding ratios obtained by comparison of the rates of mortality in the two classes are as follows:—
Among children aged 5-7 years the death rate among the unvaccinated was 1,100 per million
living, while no deaths occurred among the vaccinated. Among unvaccinated children aged 7-10
years the small-pox death rate was 170 times greater than that among vaccinated children of the
same age, while among the unvaccinated children aged 10-13 years the small pox death rate was 151
times greater than that among vaccinated children of the same age.
And even including the "doubtful" cases among the vaccinated the death rate among nonvaccinated
cases still shows a similar enormous preponderance.
The question of whether vaccination is a powerful protective against the effects of small-pox
is not one that requires further discussion. The quite different question of whether an individual
either for himself or his children is willing to take part in protecting the community against smallpox
by bearing the trifling risk involved in vaccination, or whether avoiding this inconvenience he
takes the slight, but considerably greater risk of suffering or dying from small-pox is entirely a matter
for the individual to settle for himself according to his sense of duty to himself and his fellow men.
The Council having considered the subject, decided that in event of an outbreak of small-pox
occurring in any school no enquiry was to be made as to whethei children attending the school had been
vaccinated or not, but the school was to be carefully watched day by day.
Vaccination Of Teachers.—The rules of the Board of Education requiring vaccination
in all pupil teachers and candidates for the teaching profession have now been altered, and those
candidates who are prepared to urge the plea of conscientious objections will be excused. There is
considerable risk to a teacher of coming in contact with small-pox. In spite of the requirement of
vaccination in the past the only two cases I have ever known of small-pox in teachers occurred in
both cases in men who somehow had escaped vaccination. The first case died. The last is said to
have escaped vaccination through illness, at the time it was demanded, having led to the requirement
being overlooked.
DIPHTHERIA.
In our schools during 1905-6 diphtheria has continued to show the diminished prevalence which
has been characteristic here in the last few years.
In February, 1906, there was a decided increase in prevalence, and some fear was entertained
that this might be a manifestation of a generalised and increased susceptibility likely to lead to widespread
epidemic. Fortunately, through the exertions of the Medical Officers of Health, particularly in the
three South London districts threatened, and with some extra help allowed by the Council for school
visitation, the outbreaks remained localised, and the number of schools giving rise to anxiety steadily
diminished.
Of the 21 schools requiring special enquiry during the year, 12 were under observation in
February and March.
During the year, 982 cultures were made from children seen in school, and 95 of these showed the
presence of the KlebsLöffler bacillus, 183 shewing other pseudo-diphtheroid organisms (Hoffman, etc.).
As the benefits of the method of dealing with outbreaks of diphtheria in school are not yet fully
appreciated, and some are to be found who doubt their efficacy, the following particulars of each school
may be given briefly.
From April to June, 1905, three schools only showed signs of becoming foci of dissemination.