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escents has diminished one-fourth after ten years of age, and therefore shows
the great importance of re-vaccination after that age. Not one of the 68
cases of ten years and under 15 years was stated to have been re-vaccinated.
Of the many accounts of nurses of Small-pox Hospitals, I have not read
of a single case of small-pox occurring amongst those who had been revaccinated.
Germany affords practical evidence that small-pox can be stamped out by
vaccination and re-vaccination ; for since the year 1874, re-vaccination
before leaving school has been compulsory, and during the past ten years
small-pox has been almost extinct, being at the rate of only one case per
million of the inhabitants, and these few cases are those of foreigners, or
natives who have not been re-vaccinated.
The Royal Commission on Vaccination is now meeting weekly to draw up
its final report, which it is expected will be presented to Parliament before
this session closes. It is to be hoped that this will give an increased stimulus
to increased vaccination and re-vaccination.
SCARLET FEVER.
There was an epidemic of scarlet fever during the months of August,
September, October, and November, there being nearly eight times the
number of the notifications of the corresponding months of 1894. During
the same four months there was also three times the number of diphtheria
cases compared with 1894.
This very much increased the work of the Sanitary Department, especially
as the Hospitals of the Metropolitan Asylums Board were full, both for scarlet
fever and diphtheria patients, so that instead of being able to have a case at
once removed, I had to carefully examine the urgency of each case, and report
the same, day by day, to Norfolk House. I made arrangements for isolation
as far as it was possible, but even the most urgent cases, those in tenements
of only one room, could not be removed till after many applications. Four
and five cases occurred one after the other in the same tenements. Two or
three cases in the same tenement was of frequent occurrence.
In several instances a mild case that had not been notified and isolated
was the cause of several other cases.
During the six months I have records of three of the so-called " return "
cases of scarlet fever, that is, of another case of scarlet fever occurring in a