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34
the parents asking if they have any objection to their examination, and in case of such
objection in any particular case, that such examination shall not take place; and that
the Local Government Board and the public vaccination officers be informed
accordingly."
The results of examination of the arms of school children are given in some of the
reports of medical officers of health. In Hackney there were 30,990 children on the
rolls; in the case of 15,016 children there were refusals of parents to permit examination,
and of 12,890 children examined 3,461 were found to be unvaccinated. In Finsbury
there were 15,652 children on the rolls; for one-third there were refusals, but among
the remaining two-thirds examined 2,617 were found to be unvaccinated. In Wandsworth there
were 16,142 children on the rolls; for 5,212 there were refusals, and of 8,967 children examined
1,138 were found to be unvaccinated. In Fulham, of 21,121 children on the rolls, 12,487 were
examined, and of these 870 were unvaccinated. The number subsequently vaccinated was 367.
In the St. Giles and Bloomsbury division of Holborn there were 2,920 children on the rolls; for
263 there were refusals, 2,657 were examined, and 568 found to be unvaccinated. In the Holborn
division there were refusals for about one-third of the children on the rolls, and about another
third were found to be unvaccinated. As the result of the examination, fully 1,000 children in
this division were vaccinated, and more than another 1,000 re-vaccinated. In Westminster, in
St. George's Union, 780 unvaccinated school-children were found, in Westminster Union 738
unvaccinated children were found among 2,994 examined. In this Union in 168 instances the
parents refused to allow their children to be examined, but 76 of these children were subsequently
vaccinated. In the Strand Union, of the children examined, 88 were found to be unvaccinated, but
the arms of 116 children were not permitted to be examined. In Chelsea 6,779 children were
examined, but the results are not stated. Altogether the arms of children were examined in the
City and in Kensington, Fulham, St. Marylebone, Westminster, Islington, Bermondsey, Wandsworth,
Greenwich, Lewisham, Woolwich, Hackney, Holborn and Finsbury. Notwithstanding
the large number of parents who refused to allow their children to be examined, great impetus was
given to the vaccination of children, and in some degree the arrears of vaccination in recent years
was overtaken. It is interesting to note that only two instances are mentioned in the annual
reports of the closure of schools on account of the occurrence of smallpox among the scholars.
These schools were situated in Bermondsey.
In the annual report for the year 1900 it was stated—
Estimates may, however, be made of the proportion of children under ten years of age in the London
population who in 1898 were unvaccinated, assuming that the general rate of mortality has been the
same among vaccinated and unvaccinated, and that those who in the vaccination returns are described
as "unaccounted for" were not subsequently vaccinated. By applying the figures of the English life
table of 1881-90 to the number of children "unaccounted for" in respect of vaccination in each year
of the period 1889-1898, it is found that approximately 25 per cent. of the children born during that
period and surviving to 1898 were unvaccinated. If these populations are applied to cases of smallpox
properly belonging to them received into the hospitals of the Metropolitan Asylums Board, of which
16 cases had vaccination cicatrices and 428 had no vaccination cicatrices, the attack rates are 21 per
million and 1,715 per million respectively. In other words, for every child attacked among those having
vaccination cicatrices, 82 children were attacked who had no such cicatrices. The number of deaths
among the former class was nil, among the latter class 131, giving death-rates of 0 and 525 per million.
In similar way, if the cases and deaths under ten years of age in the ten years 1893-1902
are applied to two populations, viz., about 75 per cent. vaccinated and about 25 per cent,
unvaccinated, thus including the epidemic years of 1901 and 1902, a very different result is
obtained. Instead of 82 unvaccinated children being attacked to one vaccinated child, only 29
unvaccinated children were attacked to one vaccinated child, and instead of 131 unvaccinated
children dying to 0 vaccinated, 912 unvaccinated children died to one vaccinated.* The annual
report of the medical officer of the Local Government Board for the year 1901-2 shows an increase
in the number of primary vaccinations at "all ages" in 1901 of more than 29 per cent. over the
number in 1900. The return of the vaccination officers for the years 1901 and 1902 are not vet
published, but through the courtesy of the clerks of the Boards of Guardians I have been supplied
with information as to the number of primary vaccinations in that year in 21 unions. This information
shows that in these Unions the number of primary vaccinations at all ages was in 1902 over
60 per cent. more than the number in 1900. If this increase has been maintained throughout the
whole of London, and such vaccinations had been solely among children under 10 years of age,
it would not, as an arithmetical statement, suffice to explain the whole of the fall in the proportion
of attacks in unvaccinated children as compared with the attacks in vaccinated children, but
it needs to be recollected that this larger number of vaccinations in 1901 and 1902 would necessarily
have taken place especially in infected houses and areas, and would thus have determined
the alteration in the proportions noted in much greater degree than if they had been evenly
distributed throughout the population. Nevertheless, the neglect of vaccination in years preceding
1901 and 1902 has not been without its influence in determining the relative incidence in the
several Unions of attack by smallpox of children under 10 years of age in proportion to the attacks
at all ages.t This will be seen by reference to diagram VI. which is based upon the London
cases admitted during the epidemic into the hospitals of the Metropolitan Asylums Board.
(f) Measures adopted for the prevention of the spread of smallpox in common lodging-houses.
—In the period August, 1901, to August, 1902, about 800 residents in common lodging-houses
were attacked by smallpox, the first case occurring on the 28th August, 1901. The distribution of
cases in these houses in London is shown in the following table—
* It has been stated that one of the children who died, and who was included among the unvaccinated, had been vaccinated. In
such event, this would reduce the proportion to one death among the vaccinated to 459 deaths among the unvaccinated.
† As the figures relating to infants "not finally accounted for" in the vaccination returns in the epidemic years 1901 and 1902 are
not yet available, the number of cases of smallpox occurring among children aged 0-1 has been excluded from the figures upon which the
diagram is based.