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7
these five years. Hackney has suffered since the commencement
of the epidemic, at the very high annual rate of 229.5 per
100,000 population, which is, as just shown, very far in excess of
that for all London.
As, however, vaccination has of late been very actively
carried out in the district, it is to be hoped if the present rate be
maintained, that small pox will become much less fatal in future
than it has been on an average of the last seven years.
The examination of the children attending the School
Board's schools in this district shows that a very large proportion,
something like 25 per cent. of the children under 12 years, were
not properly protected by a sufficient number of satisfactory
vaccination marks against an attack of small pox. I had some
correspondence with the Local Government Board on this
subject, and was informed that payment cannot be made out of
the public funds for the re-vaccination of children under 12 who
have been successfully vaccinated. The correspondence did not
define what is meant by "successfully vaccinated," but as
experience has shown that less than three good marks are not
sufficiently protective, I consider that either the fees should not
be paid in the first instance, unless three good marks resulted
from the vaccination, or else, that during an epidemic, all those
who have not that number of good marks should be re-vaccinated
at the public expense, if the parents cannot afford to pay for the
operation, even if they are under 12 years of age. It is somewhat
difficult to draw the precise line of'"successful vaccination,"
but undoubtedly a single white mark or even more, without
any depressions, cannot be considered protective. It should not
be forgotten that vaccination is not so simple a matter as it
seems to be, for due care must be used in selecting and storing
the lymph, whether it be on points or in tubes; and some febrile
excitement should result, for unless the disease, vaccinia, which
the vaccination should cause, be induced, the proper protective
power of the lymph will, most probably, not be afforded.