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since infancy previous to becoming infected. They were, however, re-vaccinated after receiving
the infection, and both developed mild attacks of the disease from which they recovered
From the beginning of the epidemic in October, 1901, till the end of July, 1902, there was
a total of 20,890 vaccinations, which included 6,032 primary, and 14,858 re-vaccinations,
performed by the public vaccinators in Bermondsey. There was also a great number of
vaccinations performed privately, but there is no way of arriving at the exact figure on this point.
I do not doubt that this measure has taken a great part in the prevention of the spread of the
disease in Bermondsey.
When small-pox invaded Bermondsey it was generally considered to be a badly vaccinated
borough, and this probably with some truth. For some years the Vaccination Act had not been
properly enforced. In Bermondsey it had been the custom of many practitioners to vaccinate
with one mark. Their defence is, that if they did not give in to the wishes of the parents they
would get no vaccination at all to do. There is a great deal of truth in this, since I have very
commonly heard from parents that their sole reason for not going to the Public Vaccinator was
that he vaccinated in four or five places. Though the present system of vaccination has probably
got some communities better vaccinated than the old one of vaccination stations, it is far
from ideal. The great objection from the practitioner's point of view is, that it gives a practitioner
in a neighbourhood power to visit the patients of other doctors, and although as a whole the
Public Vaccinators have acted in a most honourable spirit, and have, so far as I know, never
wilfully abused their position, still they cannot always prevent a certain number of patients from
returning to them for treatment in complaints other than those due to vaccination. The present
vaccination system, which is only temporary, will come to an end next year, and I would suggest
that every general practitioner be made a public vaccinator, and get a moderate fee for each
vaccination, provided it was up to the Local Government Board's standard. To keep them up to
this there would require to be appointed a vaccination superintendent who would examine all
arms, and grant the certificate. The advantages of this system would be: —(1) less complaint on
the part of parents, as each practitioner would look after his own families and make sure they
were vaccinated; (2) Doing away with the one mark vaccination; and (3) Removing any grounds
of complaint on the side of the general practitioner. Complaints have been made in a few cases,
both lay and medical, of the large fees which the public vaccinators have got during the present
epidemic, but, as I have said in reply, it is not the fault of these gentlemen; they did not make,
but are only carrying out, the present law.
In conferring immunity against attack, the advantages of re-vaccination are so very great that
I think legislation should be introduced, making re-vaccination at a certain age compulsory. A
very good age for re-vaccination is between 10 and 15. Such legislation exists in Germany where
small-pox is practically extinct. That it has been of great advantage in Bermondsey is shown by
the few patients attacked who had been re-vaccinated previous to becoming infected, and also
by the fact, alluded to already, that not a single child in the infant and girls' departments of the
Trinity Schools, Rotherhithe, though daily exposed to infection, contracted small-pox during the
epidemic.
The question of a change of the vaccination authority has come before the Public Health
Committee many times, but they mostly declined to express an opinion except once, when it was
that vaccination should be transferred to the Borough Councils in London. I would prefer to
see it under some central authority such as the Local Government Board, but failing this under
the Borough Councils, since being sanitary authorities, it is more natural that such an
important sanitary measure as vaccination should be administered by them.
Isolation.
On the receipt of a notification of small-pox, a copy of the certificate was made out and
brought by an inspector to the house and the case telephoned away. By this means all the
cases were removed mostly within a couple of hours of the receipt of the notifications to one of
the Metropolitan Asylums Board hospitals. If the case occurred out of routine office hours, there
was an arrangement by which the hall-keeper at the Town Hall, Rotherhithe, got the case away
either per telephone, or if too late for that, by going straight to the Ambulance Station at Old
Kent Road. The disinfectors were also immediately communicated with; so that whether the
case was removed day or night, disinfection was performed immediately. There was no
difficulty getting any of the cases away, as almost all of the patients and their friends showed a
great willingness to help the authorities in their endeavour to check the spread of the disease.
Disinfection.
This was invariably done immediately after the removal of the patient. The disinfectant used
for fumigating the rooms was a 2 per cent. solution of SO2 made by carefully sealing up all
crevices in the room and burning 21bs. of sulphur to every 1,000 cubic feet. The clothes and all
articles in the house, including the infected clothing of the remaining inmates, were removed
generally after sulphuring the room, but sometimes before, and put into a steam disinfector heated
up to 120 Centigrade. The steam is under high pressure similar to an ordinary engine boiler so
that it penetrates all parts of the fabric. It has been found sufficient to thoroughly destroy the
most resisting micro-organisms as well as their spores. It however destroys some articles
notably leather. Where there was a fabric which could not be done in this way, it was placed in
the disinfector along with a burning formalin lamp. A very strong solution of this gas was
generated which was almost, if not quite as effectual as the steam, and left no ill effects on the
fabrics. This gas is extremely diffusible and will penetrate almost anything, so that in a strong
solution very few microbes have a chance of escaping. After disinfection was performed a notice
was served on the landlord to strip and cleanse the walls, and in default this was done by the