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An individual who contracts smallpox feels nothing for about twelve days, when
it is common for headache and symptoms suggestive of influenza to develop. About
three days after these symptoms the spots appear.
It is a fact of administrative importance that a person developing smallpox is
not himself infectious until the first appearance of the spots. It is for this reason
that contacts may safely mix freely with their fellows provided that they will undertake
to go to bed and send for a doctor if they feel unwell.
The protection afforded by vaccination gradually wears off. It is extremely
rare for an individual vaccinated in infancy to catch smallpox under 10 years of age.
It is less rare up to 20 years of age. After 20 years of age vaccination in infancy is
likely to have the modifying effect of making the attack milder than it would otherwise
have been.
The following quotation from the Report of the Metropolitan Asylums Board and
its work by Sir Allan Powell is valuable evidence of the efficacy of vaccination, viz.:—
"The immunity from the disease of the Board's staff in contact with
smallpox has been remarkable. At the outbreak of the epidemic of 1901-02
there was a record for the period since 1884 of 17,900 smallpox cases dealt with
by a staff of 2,198 persons, among whom there was no single instance of the
disease being contracted where there had been successful re-vaccination."
An individual who has been exposed to smallpox infection can be protected by
successful vaccination within the first day or two of such exposure. If, however,
there is undue delay, vaccination does not protect.
An important Ministry of Health Order on the subject of vaccination was issued
in August of the year under consideration. The following instruction in this Order
contains an important departure from established procedure, viz.:—
"In all ordinary cases of vaccination or re-vaccination the public
vaccinator should vaccinate in one insertion, preferably by a single linear
incision or scratch not more than a quarter of an inch long merely through the
epidermis."
In the Ministry of Health Circular accompanying the Order, reference is made to
post vaccinal nervous disease and the following opinion is expressed:—
"The Minister recognises that 'post-vaccinal nervous disease,' both in
this country and abroad, has occurred in children of school age or adolescents
who had never previously been vaccinated, and that this fact emphasizes the
desirability of securing the successful vaccination of infants. Where this has
not been attained, the question which arises is whether it is advisable to
vaccinate children of school age or adolescents. The Minister is of opinion that,
in the present state of knowledge, and so long as the smallpox prevalent in
this country retains its present mild character, it is not generally expedient
to press for the vaccination of persons of these ages who have not previously
been vaccinated, unless they have been in personal contact with a case of
smallpox or directly exposed to smallpox infection."
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