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42 per cent. had been only once vaccinated (about one-fourth of these said they had
had smallpox.
4 per cent. were unvaccinated (all had had smallpox).
In the two above-mentioned surveys the facts noted were observed as carefully as
was practicable; in the first of these the arms of all the women were examined by
Dr. Farrar or by myself; the particulars as to antecedent smallpox were, however,
necessarily based upon the recollection of the individuals in question, though in several
instances the statements were corroborated by the fact of the existence of the characteristic
scars.
The two surveys only relate, unfortunately, to a comparatively limited number of
cases. In the investigation now to be referred to a much more extended inquiry was
made, but the statements rest absolutely upon the authority of the common lodging-house
inmates, no examination of the arms of these persons having been undertaken.
(c) Mr. Shapley, between 18th April and 8th May, 1902, questioned 1,000 inmates
(750 men and 250 women) of common lodging-houses in Stepney as to vaccination, revaccination,
and previous attack by smallpox. The cases were in no sense selected, save
in so far as they did not include a few cases which had been removed to hospital during
the preceding three or four months suffering from smallpox. Twenty-seven persons
who had been so removed, and had recovered and returned to Stepney, were included
in the 1,000 cases, but some ten or twenty cases over and above this number would
have to be allotted to the 1,000 cases in order to make the sample a complete one. As
in the previous surveys, however, the inclusion or exclusion of these cases would have
had no great influence upon the percentages obtained.
Among the 1,000 cases, 240 had been vaccinated since the commencement of the
epidemic. In order to make comparison between the results obtained in (c), and those
obtained in (a) and (6), the fact of such recent vaccination must be ignored.
Of the 1,000 persons, 224 said they had had smallpox (27 of them having suffered
during the present epidemic). Two of the 224 said they had had smallpox twice.
Of the 250 women—
101 stated that they had been vaccinated in infancy and subsequently
re-vaccinated.
136 stated that they had been vaccinated in infancy only, or only vaccinated
on one occasion.
Thirteen stated that they had never been vaccinated (seven of these said they
had had smallpox, two having been attacked during the 1901-02 outbreak).
Fifty-six of the 250 said that they had suffered from a previous attack of smallpox,
some 50 of these having so suffered prior to 1901.
Thus, approximately, 40 per cent. were vaccinated and re-vaccinated; 54 per cent.
were only once vaccinated; G per cent. were unvaccinated.
Of the 750 men—
305 stated that they had been vaccinated in infancy and subsequently
re-vaccinated.
366 stated that they had been vaccinated in infancy only, or only on one occasion.
Seventy-nine stated that they had never been vaccinated (30 of these said they
had had smallpox, one of them having suffered in the present outbreak).
168 of the 750 said that they had suffered from a previous attack of smallpox,
some 148 of these having so suffered prior to 1901.
Thus, approximately, 41 per cent. were vaccinated and re-vaccinated; 48 per cent.
were only once vaccinated; 11 per cent. were unvaccinated.
(d) Mr. Shapley in September, 1902, questioned 100 men in Woolwich in a similar
way to that described as having been adopted by him in Stepney; 14 of them had been
vaccinated since the commencement of the 1901-2 epidemic, but the fact of such recentvaccination
will, as in the case of Stepney, be here ignored, in order to make the figures
given comparable with previous figures. It then transpires that—
40 stated that they had been vaccinated in infancy and subsequently revaccinated.
51 had been vaccinated in infancy only, or only once (of these five said they
had had smallpox).
9 stated that they had never been vaccinated (of these six said they had had
smallpox).
It will be seen that inquiries (a) and (6) give a larger percentage of vaccinated and
re-vaccinated that of "once vaccinated,'' while in the case of (c) the "once vaccinated" exceed the
vaccinated and re-vaccinated, in both sexes, and the same holds true in (d). Again, the percentage
of unvaccinated is rather higher in (c) (men) and (d) than in (a) and (6). The differences may be
in part due to differences associated with the fact that inquiries (a) and (b) related to houses in
Central London, inquiry (c) to houses in East London, and inquiry (d) to houses in Woolwich.
I am disposed, however, to think that the method of inquiry has been the more important influence
in determining these differences, and that the results in those cases, in which actual examination
of arms for scars was made, are nearer to the truth than those based merely upon the statement
of the lodgers themselves.
The mean of the results obtained in inquiry (a) and inquiry (c) (females) gives 50 per
cent. vaccinated and re-vaccinated, 43 per cent. once vaccinated, and 7 per cent. unvaccinated.
The mean of the results obtained in inquiry (b), inquiry (c) (males), and inquiry (d) gives
45 per cent. vaccinated and re-vaccinated, 47 per cent. once vaccinated, and 8 per cent.
unvaccinated.