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it was desired to retain in their homes. The sums expended in other districts were much smaller.
Thus in Hackney, in which 467 cases of smallpox occurred, £74 11s. was expended in payments to
"contacts," and in Lambeth, in which 404 cases occurred, £53 8s. was so expended; in Paddington,
in which 117 cases of smallpox occurred, £93 was paid to persons working in laundries, at dressmakers,
and in a few other cases; and in Stoke Newington, in which 67 cases occurred,
£43 13s. 11d. was expended on "contacts." In Bermondsey, in which there were 297 cases in the
period October 12th, 1901, to September, 1902, a sum of £89 7s. 8d. was expended in compensation
for loss of work.
Large use was made of the shelters provided by sanitary authorities for the accommodation
of persons during the period in which their houses were undergoing disinfection, and sometimes
for the better observation of such persons. In certain districts in which there had been omission
to establish a shelter as part of the permanent provision for dealing with infectious disease,
accommodation for this purpose was sought. In Bethnal-green a house was obtained and
furnished; in Poplar two houses in the Bromley depot were utilised for this purpose; in Holborn,
in addition to the existing shelter, a house belonging to the Borough Council was made available;
and in Stepney three additional shelters were acquired, two at Rose-lane and one at Emmott-street.
The extent to which shelters were used varied in different districts. In Southwark effort
was made to induce the members of all infected families to enter the shelter, and thus as many
as 135 persons in 1901 and 678 persons in 1902 up to the 21st June were accommodated. Large use
was made of this opportunity to secure the vaccination of the inmates, and as many as 550 persons
were thus vaccinated or re-vaccinated.
(d) Vaccination or re-vaccination of persons exposed to smallpox infection.—The accumulation
of a large number of unvaccinated children in London rendered of especial importance
during the recent epidemic the promptitude with which vaccination was offered to the
inmates of invaded houses and the willingness of the inmates to accept the services of
the vaccinator. The reports of a few of the medical officers of health tell of the actual
results obtained under the circumstances which existed. Thus Dr. Davies gives account of 1,673
persons known to have been exposed to infection of smallpox in Woolwich. Of these, 1,171
were vaccinated within three days of exposure to infection, or had been vaccinated in the previous
ten years, and only one of these persons contracted smallpox; 420 "contacts" refused vaccination
or were otherwise unprotected by vaccination in the ten years before or within three days
after exposure to infection, and 45 of these persons contracted smallpox; eight contacts had
never been vaccinated before exposure to infection and not vaccinated within three days of
exposure, and of these 2 were attacked.
Dr. Priestley gives the result of his experience in Lambeth. He does not, as does Dr.
Davies, distinguish in his figures between a vaccination within three days of exposure to infection
and a vaccination after a longer interval, but he gives the results of exposure of Lambeth
residents to infection. Of persons over 10 years of age, 1,254 previously vaccinated persons were
re-vaccinated after exposure and 11 sickened; of 2,184 previously vaccinated persons who were
not re-vaccinated, 88 sickened; of 568 persons who had been previously re-vaccinated or had had
smallpox, 5 sickened; of 37 unvaccinated persons who remained unvaccinated, 9 sickened, and of
3 unvaccinated persons who were vaccinated after exposure, all sickened. So again, with children
under 10 years of age, 99 were re-vaccinated after exposure and 1 sickened; of 727 previously
vaccinated children who were not re-vaccinated, 6 sickened; of 109 previously unvaccinated
children vaccinated after exposure, 6 sickened; and of 73 unvaccinated children who
remained unvaccinated, 12 sickened. Dr. Priestley's figures show that the attack rate of persons
previously vaccinated and re-vaccinated after exposure was nearly .9 per cent.; of persons
previously vaccinated but not vaccinated after exposure, 3.2 per cent.; of persons re-vaccinated or
who had smallpox before exposure, 9 per cent.; of persons previously unvaccinated but vaccinated
after exposure, 8 0 per cent.; and of persons who were neither vaccinated before or after exposure,
19 per cent.
Some information under this heading is supplied by a few other reports, but it is less
detailed in its character. Dr. Bond reports that in Holborn, in all houses in which a case of
smallpox was notified on the first day of the rash, and all the people in the house were vaccinated or
re-vaccinated who had not been vaccinated within five years, no further case of smallpox arose.
Dr. Jackson states that in Fulham no case occurred among those who were vaccinated within four
days of exposure, while eleven cases occurred among those who refused to be at once vaccinated.
In Wandsworth, Dr. Caldwell Smith says, only four cases occurred among persons vaccinated or
re-vaccinated in the incubation period. Dr. Allan writes that in Westminster "a certain proportion
of persons who had been in contact with cases of smallpox were found to be unvaccinated; as
promptly as possible they were vaccinated if they would permit it to be done, and a considerable
number of persons must have been protected thereby, as in no case did an unvaccinated person who
had been exposed to infection escape."
There is no doubt that resort to vaccination or re-vaccination of persons after exposure to
smallpox has been largely instrumental in limiting the spread of the disease in London. The
value of this measure in affording protection, however, altogether depends upon the interval of
time elapsing between the infection and the subsequent operation. Mr. Marson, who was many
years resident medical officer of the London Smallpox Hospital at Highgate, wrote—
"Suppose an unvaccinated person to inhale the germ of variola on a Monday: if he be
vaccinated as late as on the following Wednesday the vaccination will be in time to prevent smallpox
being developed; if it be put off until Thursday, the smallpox will appear but will be modified;
if the vaccination be delayed until Friday, it will be of no use, it will not have had time
to reach the stage of areola, the index of safety, before the illness of smallpox begins; this we
have seen over and over again, and know it to be the exact state of the question. Re-vaccination
will have effect two days later than will vaccination that is performed for the first time, because