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At the expiration of that time the Order was not extended.
It should be mentioned in this connection that a voluntary system of notification
of Chicken-pox has been in operation in the City since the Small-pox epidemic of
1901-2.
The difficulty of differential diagnosis is greatly increased by the fact that so little
opportunity is given to medical students to study the disease clinically.
The admirable organisation of the Metropolitan Asylums Board removes all cases
notified to their hospitals, and this, while of the greatest benefit to the community
at large as regards infection, creates an absolute dearth of material for the instruction
of students in hospitals.
The Board has recently made new regulations to meet this difficulty, by admitting
students to their Small-pox hospitals free of charge, under certain regulations, and this
appears to be all that can be done in the matter.
SMALL-POX.
A small outbreak occurred during the early part of the year affecting chiefly
Stepney, Shoreditch and Bethnal Green.
The last serious epidemic of Small-pox occurred in 1901, and after the prolonged
absence of the disease from the Metropolis, many people (especially those of the poorer
classes) have unfortunately availed themselves of the provisions of the Vaccination
Act, 1907, thus largely increasing the number of unprotected persons.
In the City of London the percentage of unprotected persons has risen from
1*7 per cent, in 1906 (the year before the passing of the Act) to 11.9 in the present year.
In the epidemic under review, 64 cases were notified within the Administrative
County of London.
Although no cases occurred in the City, the epidemic gave a considerable amount
of work, owing to the fact that a large number of persons had been in actual contact
with patients, and were engaged in work in the City, and this occasioned many visits
for the purpose of urging re-vaccination and vaccination, and when your officers were
successful in obtaining the " contacts'" consent, the detail arrangements had then to be
made with the Vaccination Officer.
The following details may be of interest in considering the source of infection and
the cases affecting the City.
Case No. 1 was a youth aged 19, living in London, who until the 25th February was
engaged in business in the City. Upon the 25th February he was found to be suffering
from Small-pox and was removed to hospital. His fellow-workers were re-vaccinated,
and the premises disinfected. Upon the 9th March, the wife and two children of one of