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infected. The Medical Officer of Health cannot be expected
to examine all the children to see whether they are free from
infection, and therefore his certificate in regard to disinfection
of premises might lead to misunderstanding.
Small-pox.
There were 28 notifications of this disease received
during the year, with 5 deaths. This is the first year for
8 successive years in which there has been a death from this
disease in the District. Most of the cases were of the modified
form and isolated cases. It is worthy of mention that
every case which had not been vaccinated died. Of the 5
deaths, 3 had never been vaccinated, one had been vaccinated
only in infancy, and the remaining case was believed to
have been vaccinated only in infancy, but there was no
reliable history.
At the beginning of March we were threatened with a
serious outbreak in Lower Sydenham. The case occurred in
a densely populated district, near the Gas Works, and there
were 5 other members of the household. The case was that
of an old nurse who had only come to live in the house a
few days when she developed a confluent small-pox rash,
and was sent to hospital at once, where she died in three
days. All the other members of the household were immediately
vaccinated and completely isolated. Three granddaughters
of the patient contracted the disease, and it is
interesting to note that the vaccination took in all three
cases, and so thoroughly mitigated the disease, that although
they had contracted small-pox before the vaccination, the
rash appeared in a very mild form and their illness was comparatively
slight. The severity of the type of the disease
was shown by the confluent rash of the first patient, and the
fact that she died on the third day of the rash, and also
from the fact that a child, aged 6, who had seen her unknown
to us, also contracted confluent small-pox and died. This
visit was kept from the Sanitary Authorities till too late, and
the child was consequently not vaccinated. Both its mother