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In spite of the most energetic measures to stamp out the
occurrence of smallpox in Camberwell last year, cases continued
to be reported weekly up to the time of the preparation of this
report. The possible reason why smallpox has not been exterminated
in London is because it is not the virulent type of the
disease; the attack in many cases has been so very slight that the
sufferers have neglected to obtain medical assistance until the
disease was well advanced, and there have been instances also
where it has never been sought. Further, in a community
with so many opposed to vaccination, some have stated quite
openly that they would prefer to have the disease in its present
form rather than be vaccinated. The prominence given of late to
the possibility of a form of encephalitis occurring after vaccination
in late childhood and adult life has, no doubt, considerably
influenced this opposition to vaccination. Unfortunately, too,
it is an exceedingly difficult matter to instil a sense of understanding
into the minds of a certain section of the public that the
control of the disease depends largely on giving accurate information
to the officers of this Department in the course of investigation
of cases.
The factors responsible for spreading the disease may therefore
be summarised as follows:—
1. The unvaccinated state of the population resulting in a
large number of unvaccinated contacts. Experience has
also shown that there has been a marked disinclination to
be vaccinated until more than one case has been removed
from the house, and in one instance absolute objection to
vaccination was encountered. In this family 9 of 11
persons were removed to hospital suffering from the
disease.
2. Unrecognised cases due to the absence of severe physical
symptoms and neglect in some cases to seek medical
advice until the characteristic eruptive features of the
disease threaten facial disfigurement.