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contracted outside the Borough, two of them being due to visits to the
hospital ships to see relatives there ill with small-pox. In one of these
cases the patient declined revacoination on the occasion of his visit; in
the other, as previously stated, although the vaccination (primary) was
successful, a mild attack of modified small-pox subsequently supervened.
Of the 7 secondary cases, where the infection was contracted from
a previous case within the Borough, in one case the patient was at
work in a house where a man was ill with small-pox, but this information
was withheld from me, so that he was not offered revacoination.
In another case, an unvaccinated baby was infected by her father, who
was an anti-vaccinator, and would not allow his child to be vaccinated.
This child died in hospital, while the father was still detained there.
In another case the infection was contracted by the patient standing in
the street to watch the removal of a small-pox case, which occurred a
few doors away in her street. The other four cases were traceable to
two cases in one house (mother and unvaccinated child of 3 years), who
were believed to be suffering from chicken-pox, until the occurrence of
subsequent cases made the nature of their illness apparent.
Excluding the common lodging house in Smith-street, where 3
cases occurred, there were altogether 35 houses where the small-pox
patient had been in contact, or presumably might have been in contact,
with other people residing in the house or with visitors to the house.
It is very difficult to estimate correctly the exact number of these so
called "contacts," but so far as could be ascertained, there were
altogether 304 contacts in connection with these 35 houses. Out of the
304, 68 were either persons recently re-vaccinated or otherwise
presumably protected against the small-pox, or children under 10 years
of age who had been vaccinated in infancy. These were not offered
re-vaccination by the Public Vaccinator, but the remaining 236 were
offered re-vaccination by the Public Vaccinator, within as short a period
as possible after the removal of the small-pox case to hospital. Out of
this number (236), 134 or 57% availed themselves of the proffered
protection, and 102 or 43% declined to do so. Notwithstanding the
comparatively large per-centage, having regard to the circumstances, of
persons refusing to avail themselves of the proffered protection, it is
satisfactory to be able to record that the only secondary case in a house
attacked, due to the neglect of this precaution, was that of the
unvaccinated infant above alluded to. In all the other houses there
was no spread of the disease after the first case had been notified and
removed. The failure of the disease to spread in houses invaded, is
very largely due to prompt and early notification and removal. In 29
out of the 43 oases, removal was effected before the end of the 5th day
from onset, or the 3rd day from appearance of eruption. In 40 cases
the removal was effected before the end of the first week of illness.
The infectivity of small-pox is not notably great in the early stages of
the illness; and if early removal is followed by efficient disinfection of
the room and clothing of the patient, and all contacts are offered
gratuitous vaccination, the experience of Chelsea seems to show that