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that occurred only amounted to one-fourth of the number that occurred in the previous
month. A very slight increase in August was followed by a marked decline in
the epidemic. The deaths that were registered during the year amounted to 108.
This, then, has proved a far more severe outbreak of small pox than that which
signalised the years 1859-60. During those two years I obtained information of only
272 cases and 46 deaths, while during the 15 months of the recent outbreak, 577
cases and 120 deaths came to my knowledge. Although, as appears from Table II,
the disease was spread over nearly all parts of the parish, it fell with greatest severity
upon the districts in the extreme north of the Parish, where the Small Pox Hospital
is situated; the Queen's-road District, where but few houses altogether escaped the
visitation; Lower Holloway; the streets to the west of the Caledonian-road, and those
in the neighbourhood of Battle-bridge ; the Kingsland District; Balls-pond District,
in one street of which I was informed not a house escaped invasion; the streets to
the south of the Lower-road, and the Irish courts. The epidemic fell upon vaccinated
persons as well as upon those who were unvaccinated. But the character of the
attacks undergone by these two classes was widely different. Among the former, the
disease appeared in a modified form —so modified, indeed, in some of the cases, that I
saw that it was little more than an ailment almost as trifling as a common cold. Some
of these cases, indeed, were regarded as merely cases of chicken pox. On those who
were unvaccinated, on the other hand, it fell heavily, malignant and petechial cases
appearing from time to time where the locality of the patient, and the conditions under
which he was placed, favoured such a course in the disease. The influence of vaccination
in controlling the epidemic is seen in part in the returns which I made of fatal
cases in my Monthly Reports. Of the 120 deaths, there were 87 in which the previous
vaccination of the deceased or its neglect was noted. Out of the 87, there were 57
who had never been vaccinated at all, while 30 are stated to have been vaccinated ;
but of these 30 there was not one whose vaccination had been such as was satisfactory.
Nine of them presented on the arm only one vaccine cicatrix, and of these
there were but four in which the single scar could be regarded as satisfactory in its
character. Ten of them presented on the arm only 2 vaccine cicatrices, and in some
of these cases the scars are stated to have been "indifferent" in character, or
"small" and badly marked. One only presented three imperfect cicatrices, one
four imperfect cicatrices, and one is stated to have been imperfectly vaccinated in
Lombardy, where recent revelations appear to show that negligence in the performance
of the operation is rather the rule than the exception. Of the remaining
eight, two were vaccinated after the poison of the small pox had been imbibed and
the mischief done; two, aged 43 years and 26 years, respectively, had not been
vaccinated since they were infants; in one, although vaccination had been performed,
the effect of the operation was not ascertained, and three were reported to have been
vaccinated, but showed no evidence of it on examination of the arm. So far, then,
as Islington is concerned, one thing is quite clear, namely, that although vaccinated
persons suffered from the epidemic, small pox appeared in them in a modified form,
and not one who had passed satisfactorily through the protective malady died of
small pox.
The first measures adopted to meet the threatened epidemic were taken in December,
1862, when I forwarded to the Board of Trustees a copy of a memorandum upon
the subject, which I had previously laid before your Sanitary Committee, and which