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difficulties to overcome, but these should not weigh against
a suggestion of this kind if it were productive of an increased
knowledge of the disease in its various phases.
Vaccination.
The value of vaccination and re-vaccination cannot be
too strongly urged as a protective agency, and public
indifference to the need is causing much concern to those
responsible for staving off outbreaks of small-pox.
The number of cases in England has increased since
the cessation of the war, with the exception of one year,
as will be seen from the following figures: —
Year. No. of Small-pox Cases Notified.
1918 63
1919 311
1920 280
1921 336
1922 973
In 1923 over 2,000 cases of smallpox were notified, and I
have no hesitation in saying that the present situation is
grave.
The danger of a serious epidemic of this disease occurring
in England is always possible, due to the absence of systematic
vaccination, and until the people of this country realise the
value of it there will always remain a large section of the
community susceptible. It is only by the vigilance of the
medical profession that an epidemic on a large scale has not
occurred.
In London the services of' Dr. McConnell Wanklyn,
L.C.C. Consultant, and the Medical Officer of Health of
each Borough are available to assist the private medical
practitioner where a doubt exists as to diagnosis.
I am certain there is not so great an objection to
vaccination as the number of exemption certificates obtained
each year would make it appear. There is still a settled
conviction in the minds of some that arm to arm vaccination
is still in progress, and that certain diseases are transmitted
from one individual to another by vaccination. These stories
have been handed down and enlarged, with the result that
the present generation, who have not taken the trouble
to enquire into the method at present in use, develop
conscientious objections.
To-day lymph is obtained from specially selected calves
and before it is distributed for use the animal from which
it was derived is slaughtered and the body subjected to
careful examination.