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7
of 1859 they were 201, 233, 287 and 435, making a total for the year of 1156 deaths.
And yet of all forms in which death may approach a man, it is this which may be
guarded against the most readily, the most certainly, and the most conveniently. It
is not my intention to discuss the question lately mooted as to whether vaccine
lymph as now procured after years of transmission through the system of innumerable
human beings has or has not lost its pristine protective power. My own observation
and experience have satisfied me that vaccination well performed and in a sufficient
number of places, is quite as effectual in protecting against fatal small-pox now as it
was when my first acquaintance with both was made, and this too is the verdict of
others whose period of observation dates back much further than my own. I
believe the true explanation of the present spread of small-pox to lie not in the
inefficacy of vaccination as a protection, but in the negligence of parents who fail to
submit their children to the process, in the slovenly manner in which the operation
is sometimes performed, and in the carelessness which leads people to be satisfied
with the mere puncturing of the arm without affording the medical practitioner the
opportunity of pronouncing upon its success or the contrary. Partly too there can
be little question that the present spread of the disease is to be attributed to the
neglect of re-vaccination when the period of childhood and early youth has been
passed.* Prom these various causes, it arises that there is a large mass of persons in
the community, both of adults and children, who lie very much at the mercy of the
epidemic poison whenever it wanders forth to destroy. Probably the greater number
of the unvaccinated are to be met with among the poorer classes, and it is to be
recollected that the conditions under which they live and herd together many
families in a house are precisely such as to facilitate the communication of the disease.
Is it possible to estimate the number of persons thus unprotected or imperfectly
protected in Islington? Approximatively, within certain limits as to age, I think it is.
Shortly before writing this report, I made, at the request of the Board of Trustees,
and assisted by their Medical Officers, a careful examination of the children attending
the several poor and charitable schools in the parish. The following is very briefly
the result. The total number on the books was 8685, of whom I succeeded in
examining the arms of 6500. Of these, 655 presented no mark or scar on either
arm, and may therefore be pronounced to be unvaccinated, and 183 presented one or
two so faint and imperfect that the vaccination they had undergone could only be
regarded as of very doubtful protective power, and in respect of whom I felt that
I ought to advise re-vaccination. The whole of these 838 children were open
to attack of small-pox of greater or less severity. There cannot I think be less
than 48000 children in Islington under 15 years of age, that is of the ages usually
met with in charitable schools; but if we make an allowance of 8000 for the
children of the more wealthy whose vaccination has probably been carefully
attended to, and if in respect of the remainder we assume that the proportion of
unprotected is the same as in the 6500 examined, we arrive at the number of about
4030 either born in the parish or brought in to it from other places who have never
been successfully vaccinated at all, and of about 850 who are only vaccinated
imperfectly. Probably the latter estimate is much too low, as where the children in
the schools were very young I did not consider it desirable to recommend revaccination
so long as even an indifferent vaccination scar was visible on the arm. It
would be a salutary regulation in charitable schools that no child should be admitted
unless its satisfactory vaccination shall have been previously certified by a competent
medical gentleman—a suggestion which I submit for the consideration of the
committees of these institutions.
*This remark applies principally to the spread of tho disease in an epidemic season, when adult porsons
vaccinated in infancy and who might bo sufficiently protected for ordinary non-epidemic seasons, are more
endangered than persons who have recently undergone the vaccine disease. For furthur imformation on
this subject, see Mr. Simon's Report on Vaccination (published by the general Board of Health) p. 29, etc.