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5
enter upon their duties, a great check would be given to the
extension of the disease. It is, however, much to be regretted
that the Local Government Board has not taken some measures
which would lead to a more general re-vaccination of adults.
Thus, the present fee payable to the district vaccinators is so
utterly inadequate to the trouble entailed by the re-vaccination
of adults, that they can scarcely be expected to carry it out in an
energetic manner. The comparative immunity of those who
have four good vaccination marks shows that vaccination has not
lost its protective power; but that the operation was performed
at many of the public stations before 1872, and by some private
medical practitioners in a comparatively ineffective manner.
This is of course all the more reason for a general re-vaccination
of all over 15 years of age, and of those between 7 and 15, who
are not protected by a sufficient number of good marks. If
this were done, I have but little doubt that cases of small pox
would be comparatively rare, as the system of arm to arm
vaccination is much more certain and effective than the old
plan.

In the month of January the disease was slightly on the
decline in this district, as there were 197 cases against 209 cases
in November and 201 in December, 1876, and 39 deaths against
47 deaths in December, 1876.* This decline gradually continued
until only 4 fresh cases were reported to us in August without
any death having occurred in that month. As soon as the cold
weather set in the number of cases increased, although slowly,
until November, when the cases and the deaths became much
more numerous. The mortality in Hackney during the present
*See my Annual Report for 1876