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8
26th October—
18th December
(Lambeth).—1 fatal case (school child). Source not traced,
but probably connected indirectly with Poplar outbreak.
(Bermondsey).—1 non-fatal case. Origin not determined.
(Southwark).—3 non-fatal cases in one family, one of which
was not notified, having recovered at the time of discovery
of outbreak in family. Probable source in Poplar, where
the "missed" case went to reside temporarily about
time of infection.
As successful vaccination at first confers complete immunity from smallpox,
and this immunity like that conferred by other infectious diseases gradually lessens,
the main interest in the vaccinal condition of the above reported cases is to note
the shortest interval which has elapsed between successful vaccination and any
attack of smallpox, and between successful vaccination and a fatal attack of smallpox.
The 65 patients may be classed thus
(a) Vaccination doubtful, 5; (6) unvaccinated, 14; (c) previously vaccinated, 46.
(a) Five showed no signs of vaccination, and it was doubtful whether it had
been performed or not. Three died, 2 recovered.
(b) Of the 14 unvaccinated 7 died, 7 recovered.
(c) 46 had been vaccinated in infancy, 10 died, 36 recovered. The three shortest
intervals between primary vaccination and the attack were 14, 16 and 16 years
respectively. The three shortest intervals between primary vaccination and a
fatal attack were 43, 44 and 49 years respectively; the ages of the other fatal cases
vaccinated in infancy being 58, 66, 66, 67, 69, 72, 73 respectively.

During the outbreak in October and November vigorous measures were taken
to secure the vaccination and re-vaccination of unprotected persons, and more
especially school children, and altogether upwards of 25,000 children were vaccinated
in the Council's schools by public vaccinators. More could have been accomplished
in this way but for difficulties arising owing to public vaccinators in certain districts
not being authorised by the local Boards of Guardians to vaccinate children other
than those in their own areas. In many districts the Guardians in face of the emergency
which had arisen and acting on the authority of the Ministry of Health consented
to mass vaccinations in the schools irrespective of the children's place of residence.
It was found that out of 20,000 (approximately) children, concerning whom the
history of vaccination was ascertained, 55 per cent. had never been vaccinated.
Chickenpox was made notifiable by the Borough Councils in the boroughs of Deptford,
Greenwich, Paddington, Holborn and Camberwell for varying periods.
A brief review of the history of smallpox since 1901 provides an instructive
commentary on the widely held view that the risk of an epidemic of the disease
in this country is negligible; and that those, on the other hand, who consider it
to be a serious menace should be regarded as alarmists. In 1901 smallpox attacked
heavily, the defence was not sufficiently strong, and the disease gained foothold
and spread with rapidity. During that and the following year nearly 10,000 cases
occurred, entailing an expenditure of £500,000, or an average of about £50 per
case treated, in the smallpox hospitals alone. The epidemic did not come to an
end until 1905, and in the following six years the disease was quiescent.
It is useful here to note the defects of organisation against smallpox which
permitted the disease to penetrate London during 1901. These defects centred
mainly around one factor, namely, the extreme difficulty which had been felt in
identifying many cases of the disease. In consequence, smallpox was often completely
successful in creeping through; and, even when its true nature was suspected,