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pox contracted twenty years later. Vaccination is a local inoculation
of an infection which is so nearly allied to small-pox that
it confers the same kind of immunity as a previous attack—an
immunity seldom lasting for more than a few years, but which
has some definite relation between the interval elapsing between
the operation and the exposure to infection, and varying with
the individual. How long a thoroughly efficient vaccination
will protect a person from a long-continued powerful infection,
such as soaking day by day in the variolous atmosphere of rooms
in which persons suffering from severe attacks of the disease
are lying, is not known. It may be five, six, or more years. Hence
all returns of mortality or spread of small-pox among so-called
" vaccinated " persons tend to the confusion of the question, for
the public by the term " vaccinated," understand it to mean
" protected," whereas it may mean nothing of the sort. The
term includes a child which has been vaccinated in four places a
few months back, in which child the protection is absolute, and
the term includes a man of 40 vaccinated 39 years back, in which
the original immunity has probably worn itself out, and still
more misleading, it includes a person who a day or two after
contact with smallpox infection is re-vaccinated ; in this latter
case it may modify, but it will not kill the infection already
there.
If, however, returns were made of the prevalence of the
disease among children and persons who had been successfully
vaccinated or re-vaccinated within five years, there would not
be a scrap of evidence in support of those who declare that
vaccination does not protect. A second ground of opposition
is that vaccination causes in itself disease—this contention is
disproved on so large a scale by common experience that it need
not be dwelt on.
As stated before, the first preventive measure is vaccination
and re-vaccination. If every inhabitant in the Metropolis was
vaccinated or re-vaccinated within the next few weeks, the
Asylums Board would not be required to make any further provision
; the unprotected persons coming to the Metropolis would
be the only victims.
The next preventive is the measures to be taken in relation
to " contacts," that is to say with those who are known to have
been in contact with the disease, but are not themselves suffering
from it. In this district there are facilities for the treatment of