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large a proportion of unvaccinated children being attacked,
for:—
(а) The case-mortality under 10 years of age was 39.6 per cent.,
amongst the vaccinated 3.9 per cent., amongst the unvaccinated
41 per cent. Had the fatality remained in
each class the same as obtained for the whole number at
this age, there should have been 11 vaccinated deaths, and
269 unvaccinated. Or had the rate been that which
actually obtained amongst the "vaccinated" there should
have been only 26 unvaccinated deaths instead of 279,
whilst per contra, had the unvaccinated rate been general,
the vaccinated deaths should have been 11.
(b) The disparity is quite as marked when the type of the
attack is contrasted. For of 507 cases of severe attacks
(malignant, confluent, indeterminate) there actually occurred
only three amongst the vaccinated. Had the
proportion obtaining in the whole number been here
maintained (4 to 96) there should have been nearly 21
vaccinated attacks. Or if we take the mild attacks only,
there were 48 at these ages, of which 17 were amongst the
26 vaccinated subjects. There ought to have been only
two had the ratio between vaccinated and unvaccinated
obtained here as it did for the whole number attacked.
Again, at the "vaccinated rate" (11.5 per cent.) the severe
cases amongst the unvaccinated should not have exceeded 82,
whilst at the "vaccinated rate" also (65.4 per cent.) the unvaccinated
should have yielded 444 mild cases instead of 31.
Similarly, if the "unvaccinated rates" had obtained, there
should have been 19 instead of 3 severe attacks amongst the 26
vaccinated subjects and only 1 mild case instead of 17.
Indeed in whatever way the question is regarded it is beyond
dispute that small-pox in the vaccinated at this period of life is
comparatively infrequent (in Gloucester the attack-rate was 8.8
as compared with 30.2 in the same class at ages 10 years and
upwards), and that in those who are attacked the disease is
mostly of the mildest form, whereas amongst the unvaccinated at
this age the majority of attacks are severe.
11. From which considerations it follows that in the epidemic
here under notice the severity of the disease, its high mortality,
and its propagation were influenced and promoted by the unduly
large proportion of unvaccinated children who were exposed to
infection and who were infected.
12. As regards small-pox in the "re-vaccinated" it will be
observed that in no fewer than 190 instances were individuals
attacked who were said to have been vaccinated more than once.
The evidence of re-vaccination, however, is seldom as definite as