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practice in Hackney was very successful in getting the community
vaccinated or re-vaccinated, and no doubt contributed to the early
diminution of the disease.
I am of opinion that in the present state of the law more latitude
should be given to local authorities in the expenditure of money in
dealing with contacts, and not restrict the expenditure to special
cases as indicated in the circular letter. The amount expended
during the epidemic in Hackney in payments to contacts during
quarantining amounted to £74 lis. This is a very small sum
compared with the advantages gained by this expenditure. Our new
shelter was made available for the reception of persons while their
homes were being disinfected early last year, and became a help in
dealing with small-pox.
The last severe epidemic of small-pox in Hackney was in the year
1885. On examining the death returns for London, it will be seen
that prior to the above date, London was never free from small-pox
even so far back as 1840. In only two years were the deaths below
100, and these years were 1874 and 1875, when the deaths from this
disease respectively reached the numbers of 56 and 75. The disease
used to recur every two or three years with fatal severity. Since
1885 there has been no epidemic in Hackney until the late epidemic,
and very little in all London with the exception of the years 1893
and 1894, when the deaths n mbered respectively 206 and 93.
The causes of the immunity of London for 18 years are not far to
seek.
Firstly.—Prior to 1886, cases of small-pox were received and
treated in hospitals in London; but in this year the treatment of
small-pox cases in London was abandoned and transferred to Long
Eeach. This is a very important measure in freeing London from
small-pox.
Secondly.—Compulsory notification of infectious disease was
introduced in the year 1889. This is another important measure in
controlling the spread of infectious disease.