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Revaccination.—The deputation to the President of the Local Government Board urged the
necessity of compulsory revaccination of children at 12 or 13 years of age, a plan adopted in
Germany with such success that in the population of Berlin, to quote but one instance, small-pox
is practically unknown. On this subject the President made no revelation of the intentions of
the Government nor, indeed, of his own views.
Small-Pox and Vaccination.—This section of the report would be incomplete without a
reference to the evidence of the protection conferred by vaccination exhibited in two reports by
public authorities issued in the early part of 1902.
The first report, by the Statistical Committee of the Metropolitan Asylums Board, dealt
with, " Statistics concerning completed Cases of Small-pox treated in the Board's Hospitals during the
year 1901." It comprised particulars of 1,017 cases completed, that is, dead or recovered, during
the year. The gross mortality was 24.3 per cent.: of vaccinated cases, 14.2 per cent.; of
unvaccinated cases, 50.5 per cent. In the annnal report for 1871 I referred to the high mortality
amongst children, indicative of a (then) relatively unvaccinated population. Out of a total of
120 deaths in Kensington, 46 were of children under five years of age, including 15 under one year.
During 1901, in the whole of London, there were only 12 (out of the 1,017 completed) cases of
small-pox among vaccinated children under 10 years of age, and of these not one died ; but there
were 95 cases among unvaccinated children, of whom 52 died, a percentage of 54.7. Under
20 years there were 161 vaccinated cases, of whom three died, a percentage of 1.9; and 161
unvaccinated cases, of whom 79 died, a percentage of 49.1. The Registrar-General, in his fourth
weekly return, 1902, gave a classified table of deaths from small-pox, registered from the beginning
of the epidemic down to the 11th January, 1902. There were 64 deaths under ten years of age, not
one of a child vaccinated prior to infection, but including nine of children under five years, who
were vaccinated only after infection by small-pox. The statistics in both documents went to show a
diminution in the protective influence exercised by primary vaccination after the age of 20 years.
The report of the Statistical Committee contains striking illustrations, drawn from the records of
the Board, of the protection afforded by revaccination. It will suffice to cite one paragraph. " Of
2,198 persons employed at the small-pox hospitals between 1884 and 1900, inclusive, in which
period 17,900 small-pox cases were received into the hospitals, only 17 persons contracted
small-pox, of whom 13 were not revaccinated until they had joined the ship, and four were
workmen who escaped observation." It is added that " not one of the staff of the hospital ships
has ever died of small-pox, and not one has even suffered with the disease for the past eight years."
The second report referred to appeared in the fifteenth weekly return of the RegistrarGeneral,
the statistics having reference to the deaths from small-pox of 1,015 London residents
registered from the beginning of the epidemic in August, 1901, down to the 5th April, 1902,
classified as regards vaccination. From this we learn that of children and young persons under 20
years of age, who were not protected by vaccination, 348 had died of small-pox, only 22 deaths
from the disease having occurred among persons at the same age who were ascertained to have
been vaccinated in infancy. At ages over 20 years there were 103 deaths of unvaccinated persons;
448 of persons who had been vaccinated in infancy (including 13 who had been revaccinated only
after infection) ; 2 deaths of persons who had been vaccinated since infancy, but more than
twenty years ago; 2 deaths of persons who had been vaccinated at an unknown date, and 7 of
persons who had been revaccinated more than 10 years ago. There were also 72 fatal cases in
which the facts as to vaccination could not be definitely ascertained. In 58 of these cases the
deceased were stated to have been vaccinated, but in none of them was it claimed that revaccination
had been performed. Among the 1,015 deaths from small-pox at all ages, there were 932 cases in
which the fact of vaccination or non-vaccination was definitely ascertained. Excluding 66 in
which vaccination or revaccination was not performed until after the patient's infection, there
was only one death which occurred within ten years of the patient's vaccination ; that of an infant
aged 13 months, certified to have been imperfectly vaccinated.
A concrete illustration of the protective influence of recent revaccination, and the danger of
neglecting to secure such protection, was referred to in the second monthly report for 1902, in
connection with an outbreak of small-pox at the Mile-End Infirmary. At the time of the outbreak,
40 nurses and two matrons were on duty; 29 of the nurses and the two matrons had been
revaccinated prior to the outbreak—some recently and all within two years. None of them
contracted the disease. Four nurses were revaccinated immediately after the outbreak and none
of them caught the disease. Seven nurses caught small-pox: three of them had not been
revaccinated, the other four were revaccinated within the incubation period, i e. (as it turned out),
after they had become infected, so that they were virtually not revaccinated. The Steward of the
Infirmary was revaccinated, his Clerk not. The Steward, although constantly exposed to the
nurses, who were " contacts," escaped ; the Clerk, similarly exposed, contracted small-pox. The
medical staff were revaccinated, none of them contracted the disease.