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21
Secondly.—"Efficient" vaccination must be defined by law, and a certain
standard laid down as a minimum means of protection. There is no reason
why every medical practitioner should not act as a public vaccinator, the
results of the operation being in every case supervised and inspected by a
specially appointed medical officer entrusted with the duty of accepting or
refusing the certificate as "successful" vaccination.
Thirdly.—There should be no question as to the quality of the lymph. As
the Law requires vaccination, the State should provide the vaccine, or at any
rate guarantee its being of a standard quality.
Much of the opposition to vaccination, especially from the lower classes,
arises from a distrust as to the quality of the material employed, and an
imaginary danger of transmission of disease thereby.
If the State provided all the vaccine required, and prohibited the use of
that from any other source, one serious difficulty would be removed.
During the first half of the present year there was practically no Small-pox
in the Metropolis, 11 cases only being notified.
During July and August a few cases occurred, but at the end of the latter
month it was evident that an outbreak had to be reckoned with.
The "vitality" of the epidemic was shown by the fact that within a few
weeks cases had occurred in every district in London, and that the rate of
mortality was unusually high.
Before the end of the year, 1,017 cases had been removed to the Metropolitan
Asylums Board's Hospitals, and their Report, published early in January, gives
some interesting and instructive figures.
The gross mortality is given as 24.28 per cent.
The total mortality rate per cent, of vaccinated cases was 14.21,
of doubtful cases 65.08, and of unvaccinated cases 50.52.
Startling as these figures are, they by no means represent the actual facts.
"Vaccinated" in this Report means "cases having visible cicatrices," without
any reference as to the number, and area of such cicatrices.
" Doubtful" includes (a) " cases stated to have been vaccinated, but bearing
"no visible evidence thereof," and (b) "cases in which no statement was made,
"but in which the eruption prevented any reliable observation as to cicatrices."
With regard to (a) it is obvious that if the slightest value is to be placed
on efficiency of vaccination, the whole of these cases must obviously be
considered as unvaccinated; while with reference to (b) experience shows