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that in those instances among tho unvaccinated in which death did not occur
the ravages of the system, the impairment of vital power, the damage of
internal organs, and the facial disfigurement were far greater than in the
vaccinated cases. In the latter the disease was usually mild.
29. It must be remembered, also, that in many of the so-called vaccinated
cases, there is a decided probability that the operation had been
imperfectly performed, inasmuch as the average age of the persons attacked
having been 15 years, the majority of them had been vaccinated before the
present laws were in force for ensuring satisfactory vaccination.
Comparative Death-rate at home and in Hospital.
30. The Death-rate in all the cases was 16.6 per cent. It should be
observed that the rate per cent, of those cases treated in hospital was 13.8,
whilst of those treated at home it was 20.7 (Table No. 7)—a very considerable
difference in favor of hospital management. Another striking result,
worthy of remembrance, is gathered from our records. During the first part
of the epidemic, up to the end of August, the mortality among those cases
treated at home, in the charge of private practitioners, was only 12 per cent.;
but so soon as complaints were made of the management of the Hampstead
Hospital, the people became alarmed, and refused to allow their sick friends
to, be removed : they were thus left in their dirty and wretched homes, to
run deeper into the malady, and to poison their families; then the disease
increased in fury, especially in the Little Coram Street section, the victims
became alarmingly numerous, and the mortality mounted to 49 per cent., or
22 deaths in 45 cases treated by private practitioners. These facts ought not
to be forgotten in relation to the question of isolation for the prevention and
treatment of contagious diseases.
Re-vaccination.
31. In some instances the patient was attacked after re-vciccinatlon;
one case of the kind I have already adverted to. In another case, at 16,
Phoenix Street, a boy 12 years of age had been vaccinated six months before
the attack ; and it is reported that the re-vaccination took well. In another,
at 46, Museum Street, a boy aitat 1C had been re-vaccinated, expressly to
avert an attack: the operation was successful, (nevertheless he suffered
from Small pox. Two others in this family were ill; they were treated at
home. Two female servants, residing at 36, Alfred Place, had been re-vaccinated;
they were subsequently attacked, and sent to hospital: one died.
I could not ascertain the degree of success that had attended these re-vaccinations.
A boy getat 7, at 29, Brownlow Street, had been re-vaccinated a
clay before his attack.
32. I have thought it right to enumerate these instances of attack
after re-vaccination, without intending to lay much stress upon them as
matters of evidence. It is clear that, in the case of the boy at 29, Brownlow
Street, the re-vaccination could not have exerted any prophylactic effect,
on account of the recency of the operation. It would not be surprising,
however, if attacks of Small pox occasionally followed re-vaccination, as
they follow primary vaccination, and even Small pox itself. For example, a
boy ffitat 16, at 29, Brownlow Street, and a boy aatat 6, at 180, Ilolbom,
had each had Small pox when about one year old. A woman 25 years of
age, residing at 10, Brownlow Street, had been vaccinated, and had also
suffered from Small pox; yet she caught it a second time. A young man,
who lived at 14, Southampton Row, had been vaccinated and re-vaccinated,
and had had an attack of Small pox, yet he was subjected to a second
attack during this epidemic.
33. These are undoubtedly exceptional cases, serving to show that
there are certain constitutions which are peculiarly susceptible of organic
poisoning, and which nothing will entirely protect.