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13
ness; for, in the three years, 1877—9, in a very large proportion of
fatal cases, 28.2 per cent. in London, and 54.3 per cent. in the rest of
all England and Wales, the medical attendant was unable, or
neglected to state, in the certificate, whether the deceased was vaccinated
or not. But, confining ourselves to those cases in which the
necessary information is given, it appears that 64.5 per cent. of the
persons who died of small-pox in England and Wales, in these
three years, were unvaccinated, and only 35.5 per cent. were vaccinated.
In London, 65.4 per cent. of the fatal cases, concerning
which the necessary information was forthcoming, were unvaccinated,
while, in the rest of England and Wales, the per centage was 61.6.
"This, however, does not necessarily imply that a larger proportion
of persons were unvaccinated in London than elsewhere; the
difference might possibly be due to better and more efficacious vaccination
in London, owing to which a smaller proportion out of the
vaccinated was liable to infection."
In the Annual Summary of Births, Deaths, and Causes of
Death, for the year 1880, it appears that London, at the time
when the census of 1871 was taken, contained a population of
3,254,260, and there died of small-pox 475; of which 104, or 21.9 per
cent. had been vaccinated; 229, or 48.2 per cent. had not been vaccinated,
and in the remainder 142, or 29.8 per cent., there was no
statement as to vaccination.
In order to improve this state of things it might be desirable to
have a Public Register kept of every certified case of successful
vaccination, to which should be added the number of cicatrices in
each case. The Register should also contain the name and address
of the vaccinator, and the] name of the patient vaccinated, so that
when a case of small-pox occurred in every public hospital, reference
might be made to this Register for information relating to the name
and address of the vaccinator.
I recommended at page 8 of my Quarterly Report for June, 1877,
that vaccination should be performed only by the Public Vaccinator,
and I gave my reasons for such recommendation.