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2. The main reason for the rapid extension of the disease was the
almost simultaneous invasion of many homes through children who
were infected whilst attending certain of the public elementary
schools.
3. Another reason for the spread is to be found in the inadequacy
of the provision for hospital isolation and the enforced
abandonment of systematic "quarantine" inspection, both conditions
being due to the enormously rapid increase of the
attacked, and of the houses invaded by small-pox.
4. The outbreak might probably have subsided earlier had it
not been for the fact that reluctance to the hospital became so
general.
5. A further reason for the spread and continuance of the
epidemic may be found in the position of the hospital and the
lack of control in its administration. On the other hand the
conditions obtaining in the streets and dwellings most affected
were of themselves such as to sufficiently account for the dissemination
of the disease by direct contagion.
6. There is no sufficient evidence to support the contention
that defective drainage or other insanitary condition was responsible
for the development of the disease and for its disproportionate
incidence in the South Hamlet. But the conditions
which favour contagion were abundantly present, especially the
retention of a large proportion of the cases within their homes,
and in many instances, also, the impossibility of isolating the
attacked within the house.
7. A feature which, as well as the exceptional fatality and
severity, characterised this outbreak was the excessively disproportionate
incidence of the disease upon young children. Of the
whole number attacked (1,979) there were 706 under 10 years, or
35.7 per cent. Of the fatal cases (434) there were, in this ageperiod,
280 or 64.5 per cent.
8. Of these 706 children, only 26 were "vaccinated " (including
one vaccinated three weeks before, attack, and one who presented
no marks of an alleged primary vaccination in infancy), whilst of
the remainder 80 were "undergoing" vaccination when attacked,
the vaccination having been performed within 14 days of the
onset.
9. This proportion of vaccinated and unvaccinated amongst
the attacked, 26 to 680, or, for every 100, vaccinated four (nearly),
unvaccinated 96, may be compared with the proportions of tile
same ages and classes amongst those exposed to infection.
According to the data collected from 899 households there were,
under 10 years of age, 1,603, of whom 272 were vaccinated 1,331
unvaccinated, or, for every 100, 17 vaccinated to 83 unvaccinated.
10. There is no escape from the conclusion that the heightened
mortality and severity of the epidemic were greatly due to so