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152
If the cases treated in the Small-pox hospitals of London during
the epidemic of 1901-1902 are similarly examined, it is found that,
out of a total of 9,659 admissions to hospital, of vaccinated cases
under 10 years of age, only 2 died out of 134; of 33 doubtful cases
6 died; and of 1,274 unvaccinated cases, 442 died—a percentage of
34.69. Thus only 134 vaccinated children under 10 years of age
were admitted and they furnished a mortality of only 1.4 per cent. ;
whereas 1,274 unvaccinated children were admitted under to years
of age, among whom the mortality was 34.7 per cent.
The difficulty of diagnosis of modified Small-pox in the vaccinated
is often very considerable, and this may be responsible for
much spread of the disease, attended by much mortality, in an unvaccinated
community. That was the lesson of the outbreak above referred
to. But I fear that it will have to be repeated on a much
larger scale before it is acted upon. Owing to the prevalence of the
disease the London County Council, with the approval of the Local
Government Board, made Chicken-pox a compulsorily notifiable
disease in March, 1911, on the assumption that in the case of any
doubtful cases certified the practitioner will confer with the Medical
Officer of Health of the Borough, or with Dr. Wanklyn, who is
expert in the diagnosis of Small-pox and an Assistant Medical Officer
of Health to the London County Council.
The returns for England and Wales for 1909, when compared
with the returns for 1908, show a reduction (from 63.2 to 59.8) in the
percentage of children born who are vaccinated ; and it is clear that ''he
Vaccination Act of 1907 has been followed by a considerable increase
in the number of children exempted by Statutory Declaration,
obtained mainly at the expense of children who in the past would
have been vaccinated and protected. As matters stand at present
the average parent cannot But take the view that the Government
has no serious desire for the vaccination of his child; and even if he
has no " conscientious objection " he often gets exempted so as to
wait until a more convenient time arrives or until the danger of