- Email: [email protected]
MEETING OF PUBLIC VACCINATIORS AT PLYMOUTH
754
opinions. On the other hand, attention may be called to sug- service, payable after a service of ten years, to fortygested measures which are likely to prove futile or obnoxious sixtieths, a maximum only to be obtained after 35 years’ The proposed deductions from salary a-! conand their failure to become law may thus be rendered more service. certain. Medical Acts Amendment Bill. The private members’ Bill before the House of Commons which is of most importance in that it concerns the medical profession more or less as a whole is introduced by Sir John Batty Tuke, while it further bears the names of Sir John Gorst, Mr. James Campbell, Sir Richard Jebb, Mr. Talbot, and Sir Michael Foster. Its principal objects are to give the General Medical Council power to erase from the Medical Register for a limited period the name of a registered practitioner who has been guilty of a crime or who has been adjudged guilty of infamous conduct in a professional respect, and to enable the medical authoritiesthat is to say, the universities and other bodies entitled to grant medical diplomas-summarily to deprive a practitioner whose name has been erased from the Medical Register of the medical diploma obtained from that authority. A third provision orders that, notwithstanding the provisions of any Act in force or hereafter to be passed, all fines and penalties recovered under the Medical Acts or the Dentists Act, 1878, shall go to the General Medical Council to be applied in aid of the expenses incurred by the Council in putting into force the Medical Acts. The changes proposed to be made require but little comment or commendation. At present the General Medical Council can inflict but one penalty, the erasure of the name of the person brought before it from the The power to modify and to regulate Medical Register. the penalty to be imposed is a highly desirable one for anv punitive body to possess, for many reasons. One of these is that where the necessary penalty is not one of extreme severity offences are more likely to be complained ’of and punished than where the accusation, if successful, must necessarily involve the professional ruin of the accused. The second proposed change enables the bodies which grant medical diplomas to withdraw them subject to their possible future restoration where the General Medical Council has exercised its powers of removal from the Register ; this power to withdraw diplomas is not now possessed by all the bodies which may grant them. The third proposed change is due to the fact that in London the penalties referred to are claimed by the Receiver of Police under the Metropolitan Police Courts Act, 1839.
tributions towards these allowances are graded from 2 to 3 Contribution per cent. according to the time of service. by those already holding office is to be according to choice and various matters of detail, financial and otherwise, are considered in various sections devoted to them. Enough has been said to show that the measure is one of considerable importance to the two classes directly affected by it.
An Anti- Vaccination Bill. A brief Bill, containing but one operative section, would order that "a vaccination officer shall not take proceedings against a parent or other person under section 29 or section 31 of the Vaccination Act, 1867, except with the express sanction and authority in each case of the guardians of the union or parish for which he acts." This attempt to repeal the Vaccination Acts locally at the option of a more or less uneducated majority of the enfranchised population embodies the present ambitions of the anti-vaccinationist, as already shown in a succession of It is, defences to prosecutions and subsequent appeals. perhaps, not likely to receive the serious consideration of the House of Commons, and it is to be hoped that if it does its rtjection will be decisive. It is introduced by Mr. Channing and is supported by Sir John Rolleston, Mr. Goddard, Mr. Cremer, Mr. Brigg, Mr. Broadhurst, Mr. Corrie Grant, and Mr. Bell. An .7<- MMCOM
Bill.
This Bill seeks to amend 39 & 40 Vict. c. 77, the statute which already regulates and controls the performance of experiments upon live animals. Its main object appears to be the abolition of the existing provisions for the performance of certain experiments under certificates, which without such certificates are not permissible. Those especially aimed at are no doubt those in which it may be desired to dispense with the administration of an ansesthetic. There is also in the Bill a section ordering that "there shall be present during and throughout the whole course of the experiment an inspector," "and no such experiment shall at any time be performed or continued save in the presence of such inspector as aforesaid." Power is given to the Secretary of State to appoint a sufficient number of inspectors for this purpose. Their duties A Public Health Bill. would, however, obviously be such as only highly qualified The full title proposed for this measure is "The Public members of the medical profession could adequately perform Health (Officers’ Tenure of Office and Superannuation) Act of and the questions to be decided by them are now safely left 1903." It is introduced by Sir Francis Sharp Powell and is in the hands of the highly qualified members of the medical whose experiments at times under the existing supported by Sir Walter Foster, Mr. Talbot, Dr. Farquharson, profession Mr. Henry Hobhouse. Mr. Cripps, Mr. Heywood Johnstone, Act lawfully include those upon live animals. These experiSir Michael Foster, and Sir John Batty Tuke. Its main ments are already subject to conditions with regard to and other matteis, the stringency of which, it is objects are to insure that none but those properly qualified inspection should be increased in other directions besides shall be employed as officers of health (a definition in proposed, Members of Parwhich are included medical officers of health, sanitary those to which we have called attention. liament who have the Act and are considered and existing of to to these inspectors, inspectors nuisances) ; give acquainted with the statistics relating to its subject matter as far as is reasonable security of tenure in their offices; and to enable them by definite contributions proportionate to will for the most part be satisfied that the protection which their salaries, paid to a central fund, to provide for them- ’, it affords to dumb animals is sufficient without the additional selves superannuation allowances to assist them in the event z, restrictions proposed in a Bill which is brought in by Sir of old age or disablement. The memorandum prefixed to Frederick Banbury, Colonel Lockwood, and Mr. MacNeill. the Bill calls attention to the highly technical duties performed by sanitary inspectors and points out that as the law stands urban and rural sanitary authorities may appoint officers of health on such conditions as to qualifications, MEETING OF PUBLIC VACCINATORS AT tenure of office, and other matters as they deem fit. The PLYMOUTH. body of the Bill would enact that no person should be appointed an officer of health unless he either is the holder A MEETING was held in the room of the Plymouth Medical of a certificate of the Local Government Board or of some on Feb. 28th to elect a district council from among "Society body for the time being approved by that Board, gained by examination, or unless he has for three years before the jhe public vaccinators of South Devon and North and East passing of the Act served as an oflicer of health. This Cornwall (including members and non-members of the portion of the Bill is, no doubt, to a large extent designed association of Public Vaccinators of England and Wales). to obtain the appointment of competent sanitary inspectors, Mr. G. Jackson of Plymouth presided. The following the qualifications of these for their posts being less easy to were adopted unanimously :— êesolutions in circumstances than those of medical
appreciate
existing
who offer themselves for the posts of medical officers It also proposes to do away with the term of health. "inspector of nuisances," substituting for it the more euphonious one of " sanitary inspector." Conditions of superannuation are proposed, followed by a scale of superannuation allowances. These range from fifteen-sixtieths of the average annual salary of the last five years of men
1. This resolution referred to the constituting of a district council. 2. That the Local Government Board should be the authority to which the administration of vaccination should be intrusted. 3. That failing the entire transference of administration from boards )f guardians to the Local Government Board it is absolutely necessary n the public interests that the public vaccinator should be as indeoendent in position as the vaccination officer. 4. That the minimum fees cannot be fairly reduced, and in many Jountry districts they are inadequate on account of the distance to be
755 covered, and that
an
additional minimum fee of ls. per mile should
paid for each journey over two miles for each mile or part of a mile. 5, 6, and 7. These resolved that school children should all be compelled to produce a certificate of successful vaccination; that there should be compulsory revaccination between the ages of 10 and 14
be
years; and that " successful" vaccination should be defined in any future legislation. 8. That in the public interests all the institutions for the provision’of calf vaccine in this country should be open to Government inspection and that no imported lymph should be used from any institution which is not recognised by the English Government. 9. That there should be a Government vaccination station for the
supply of lymph in
all numerous centres of population. 10. That " efficient vaccination should be denned as at present fixed by the Local Government Board as four insertions and half a square inch of cicatrix, and that the number of insertions and successful pustules be named in the certificate and registered by the vaccination officer. 11. That every medical practitioner not acting as public vaccinator who forwards a certificate to the vaccination officer of any efficient vaccination be paid a fee for the certificate, provided that such certificate states the number of insertions and successful pustules, and that such fee should not interfere with that charged for the operation.
Public Health LOCAL
and
Poor Law.
GOVERNMENT
BOARD.
REPORTS OF INSPECTORS OF THE MEDICAL DEPART1IENT OF THE LOCAL GOVERNMENT BOARD. .
On Epidemaie Small-pox in the Union of Ursett, 1901-02, by Dr. G. S. BUCHANAN. 4-The Union of Orsett, which has a population of some 33,000, is situated in South Essex and ext,ends from west to east about 14 miles and from north to south about seven miles, the Thames forming its southern boundary throughout. The most populous portions of the union are the riverside neighbourhoods between Purfleet on the west and Tilbury on the east. The town of Grays lies midway between Purfleet and Tilbury and forms the Grays urban district ; the rest of the union is comprised in the Orsett rural district. During the ten months from September, 1901, to June, 1902, small-pox appeared in 12 out of 17 parishes in Orsett rural district, the attacks per 1000 of the population in those parishes being 18’5; while in Grays urban district 16 per 1000 of the population suffered from the disease. The epidemic was thus of great severity. It may be contrasted with the London borough of Holborn which suffered most heavily during the recent outbreak in the metropolis, where the attacks of small-pox per 1000 during 11 months ending June, 1902, were no more than 7’2. Dr. Bu,;hanan gives tables showing the incidence of smallpox week by week on the population and on dwellings in various subdivisions of the union. The epidemic had its beginning (from September to November, 1901) among the small community of Pur fleet and in persons living elsewhere in the union where the attacks could be referred to infection from others who had contracted infection at Purfleet. From the middle of November, 1901, onwards the disease became prevalent over the whole of the southern portion of the union, its incidence being especially severe upon the villages of West Thurrock and South Stifford, which lie between Purfleet and Grays, and upon the parish of Aveley which adjoins Purfleet on the north. The report deals in detail with the condition of the population of the union at the beginning of the epidemic in regard to vaccination. Since 1891 neglect of infantile vaccination had increased and from 1895 to 1900 more than one-third of the children whose births were registered had not been vaccinated. With the exception of certain special communities (which entirely escaped small-pox) comparatively few persons of ten years of age or upwards were already revaccinated when the epidemic began. Having regard to the large number of unvaccinated children, it was fortunate that no instances occurred of the spread of small-pox in schools such as happened in Gloucester in 1896. Nevertheless, it is noteworthy that out of a total of 519 cases admitted to the local small-pox hospital no fewer than 100 were unvaccinated children under the age of ten years and that 22 of these children died. During the same period only ten vaccinated children under the age of ten years were admitted, each suffering from discrete small-pox, and no death occurred among them. An instructive table prepared from data obtained by Mr. Rea Corbet shows with regard
fatality from small-pox in the unvaccinated was much greater than in the primarily vaccinated and this, not only at ages from 10 to 25 years (unvaccinated rate 14. 3 per 100, primarily vaccinated rate 3’9), but also at ages over 25 years. 18 cases were admitted in which revaccination was stated to have been successfully performed at some period or other before infection by small-pox. In four cases this period was less than ten years, in one instance no more than six years. The progress of the epidemic caused a complete change in the attitude of the majority of the population towards vaccination. By March, 1902, as many as 6763 persons had been recently revaccinated and many children over one year. had been recently vaccinated by the public vaccinators, while a large amount of revaccination and vaccination was performed by medical practitioners who were not public vaccinators. No case of small-pox occurred among persons recencly revaccinated save those who were already incubating small-pox at the date of revaecination. The most striking facts of the epidemic, however, were the severe and long-continued prevalence of small-pox in Purfleet and the evidence obtained which referred small-pox in other parts of the union In this village to infection contracted in Purfleet. throughout the epidemic cases kept on occurring week after week and month after month ; altogether 41 out of the 110 dwellings in the place were affected. During the whole epidemic period in Purfleet and elsewhere there was no failure in the arrangements for isolation, cases of small-pox being removed within !i4 hours of notification ; 11 contacts were kept under observation ; and disinfection, on the whole, was satisfactory. There was little or no evidence that small-pox in Purfleet was maintained by undetected cases or by supposed chicken-pox. Moreover, revaccination in Purfleet was freely resorted to. On a liberal estimate those inhabitants who at the end of March, 1902, were not vaccinated children, revaccinated or recently vaccinated adults, cr persons who had suffered from smallNevertheless, cases of small-pox pox did not exceed 40. subsequently occurred among these 40, while other later cases in Purfleet were persons newly arrived in the place. These considerations, along with a number of others in the report which space does not allow us to summarise, are important in their bearing on the question of the convection of small-pox infection from the Metropolitan Asylums Board’s small-pox hospital ships which are moored in the Thames off the Kent shore, opposite Purfleet, from which they are by nearly half a mile of water. There was no personal communication between the ships and Purfleet throughout the epidemic and in considering the influence of the ships, as Dr. Buchanan puts it, we have to choose between aerial convection or nothing." to adults that the
"
separated
As to the latter alternative I would say at
once
that if the presence
of the small-pox ships in Long Reach had no concern with the Purfleet epidemic, then, while making every allowance for opportunities of local spread of the disease, I am nevertheless quite unable to suggest any reason for the extraordinarily heavy and long-sustained prevalence of small-pox there. If, on the other hand, the ships did exert influence on the epidemic, infective particles being from time to time, under favouring meteorological conditions, conveyed to the area of Purfleet and there reinforcing small-pox already prevalent, or setting small-pox going anew, then not only is the Purfleet experience intelligible, but the hypothesis invoked to explain it is one that has been shown to be necessary, in our present knowledge, if the characteristic peculiarities in the distribution of small-pox in the neighbourhood of small-pox hospitals are to receive anything approaching a suftictent explanation.
Those who are interested in the question will note with interest the abundance of circumstantial evidence given in the report that the ships were responsible for disseminating infection in their neighbourhood in the way in which the London hospitals of the Metropolitan Asylums Board used to do when they received acute cases of small-pox. Instances were traced, for example, in which members of the crew of vessels moored for a while in Long Reach sickened with small-pox about 12 days afterwards. It is, of course, impossible to test the matter in this case by looking for graduated intensity of incidence of small-pox in dwellings near the hospital ships ; there are, practically speaking, no dwellings within a mile of the ships save those in Purfieet and the Dartford marshes to the south of the ships are uninhabited. But during the period under consideration large numbers of workmen were employed opposite the ships on the Kent shore in the erection of temporary buildings and among these men cases of small-pox occurred almost by the Unlike the inhabitants of Purfleet these men may score. of "mediate"infection by associa1 London : Eyre and Spottiswoode, East Harding-street; Edinburgh have had opportunities tion undetected by the authorities with members of the Oliver and Boyd; Dublin: E. Ponsonby. Price 1s. 6d.
opinions. On the other hand, attention may be called to sug- service, payable after a service of ten years, to fortygested measures which are likely to prove futile or obnoxious sixtieths, a maximum only to be obtained after 35 years’ The proposed deductions from salary a-! conand their failure to become law may thus be rendered more service. certain. Medical Acts Amendment Bill. The private members’ Bill before the House of Commons which is of most importance in that it concerns the medical profession more or less as a whole is introduced by Sir John Batty Tuke, while it further bears the names of Sir John Gorst, Mr. James Campbell, Sir Richard Jebb, Mr. Talbot, and Sir Michael Foster. Its principal objects are to give the General Medical Council power to erase from the Medical Register for a limited period the name of a registered practitioner who has been guilty of a crime or who has been adjudged guilty of infamous conduct in a professional respect, and to enable the medical authoritiesthat is to say, the universities and other bodies entitled to grant medical diplomas-summarily to deprive a practitioner whose name has been erased from the Medical Register of the medical diploma obtained from that authority. A third provision orders that, notwithstanding the provisions of any Act in force or hereafter to be passed, all fines and penalties recovered under the Medical Acts or the Dentists Act, 1878, shall go to the General Medical Council to be applied in aid of the expenses incurred by the Council in putting into force the Medical Acts. The changes proposed to be made require but little comment or commendation. At present the General Medical Council can inflict but one penalty, the erasure of the name of the person brought before it from the The power to modify and to regulate Medical Register. the penalty to be imposed is a highly desirable one for anv punitive body to possess, for many reasons. One of these is that where the necessary penalty is not one of extreme severity offences are more likely to be complained ’of and punished than where the accusation, if successful, must necessarily involve the professional ruin of the accused. The second proposed change enables the bodies which grant medical diplomas to withdraw them subject to their possible future restoration where the General Medical Council has exercised its powers of removal from the Register ; this power to withdraw diplomas is not now possessed by all the bodies which may grant them. The third proposed change is due to the fact that in London the penalties referred to are claimed by the Receiver of Police under the Metropolitan Police Courts Act, 1839.
tributions towards these allowances are graded from 2 to 3 Contribution per cent. according to the time of service. by those already holding office is to be according to choice and various matters of detail, financial and otherwise, are considered in various sections devoted to them. Enough has been said to show that the measure is one of considerable importance to the two classes directly affected by it.
An Anti- Vaccination Bill. A brief Bill, containing but one operative section, would order that "a vaccination officer shall not take proceedings against a parent or other person under section 29 or section 31 of the Vaccination Act, 1867, except with the express sanction and authority in each case of the guardians of the union or parish for which he acts." This attempt to repeal the Vaccination Acts locally at the option of a more or less uneducated majority of the enfranchised population embodies the present ambitions of the anti-vaccinationist, as already shown in a succession of It is, defences to prosecutions and subsequent appeals. perhaps, not likely to receive the serious consideration of the House of Commons, and it is to be hoped that if it does its rtjection will be decisive. It is introduced by Mr. Channing and is supported by Sir John Rolleston, Mr. Goddard, Mr. Cremer, Mr. Brigg, Mr. Broadhurst, Mr. Corrie Grant, and Mr. Bell. An .7<- MMCOM
Bill.
This Bill seeks to amend 39 & 40 Vict. c. 77, the statute which already regulates and controls the performance of experiments upon live animals. Its main object appears to be the abolition of the existing provisions for the performance of certain experiments under certificates, which without such certificates are not permissible. Those especially aimed at are no doubt those in which it may be desired to dispense with the administration of an ansesthetic. There is also in the Bill a section ordering that "there shall be present during and throughout the whole course of the experiment an inspector," "and no such experiment shall at any time be performed or continued save in the presence of such inspector as aforesaid." Power is given to the Secretary of State to appoint a sufficient number of inspectors for this purpose. Their duties A Public Health Bill. would, however, obviously be such as only highly qualified The full title proposed for this measure is "The Public members of the medical profession could adequately perform Health (Officers’ Tenure of Office and Superannuation) Act of and the questions to be decided by them are now safely left 1903." It is introduced by Sir Francis Sharp Powell and is in the hands of the highly qualified members of the medical whose experiments at times under the existing supported by Sir Walter Foster, Mr. Talbot, Dr. Farquharson, profession Mr. Henry Hobhouse. Mr. Cripps, Mr. Heywood Johnstone, Act lawfully include those upon live animals. These experiSir Michael Foster, and Sir John Batty Tuke. Its main ments are already subject to conditions with regard to and other matteis, the stringency of which, it is objects are to insure that none but those properly qualified inspection should be increased in other directions besides shall be employed as officers of health (a definition in proposed, Members of Parwhich are included medical officers of health, sanitary those to which we have called attention. liament who have the Act and are considered and existing of to to these inspectors, inspectors nuisances) ; give acquainted with the statistics relating to its subject matter as far as is reasonable security of tenure in their offices; and to enable them by definite contributions proportionate to will for the most part be satisfied that the protection which their salaries, paid to a central fund, to provide for them- ’, it affords to dumb animals is sufficient without the additional selves superannuation allowances to assist them in the event z, restrictions proposed in a Bill which is brought in by Sir of old age or disablement. The memorandum prefixed to Frederick Banbury, Colonel Lockwood, and Mr. MacNeill. the Bill calls attention to the highly technical duties performed by sanitary inspectors and points out that as the law stands urban and rural sanitary authorities may appoint officers of health on such conditions as to qualifications, MEETING OF PUBLIC VACCINATORS AT tenure of office, and other matters as they deem fit. The PLYMOUTH. body of the Bill would enact that no person should be appointed an officer of health unless he either is the holder A MEETING was held in the room of the Plymouth Medical of a certificate of the Local Government Board or of some on Feb. 28th to elect a district council from among "Society body for the time being approved by that Board, gained by examination, or unless he has for three years before the jhe public vaccinators of South Devon and North and East passing of the Act served as an oflicer of health. This Cornwall (including members and non-members of the portion of the Bill is, no doubt, to a large extent designed association of Public Vaccinators of England and Wales). to obtain the appointment of competent sanitary inspectors, Mr. G. Jackson of Plymouth presided. The following the qualifications of these for their posts being less easy to were adopted unanimously :— êesolutions in circumstances than those of medical
appreciate
existing
who offer themselves for the posts of medical officers It also proposes to do away with the term of health. "inspector of nuisances," substituting for it the more euphonious one of " sanitary inspector." Conditions of superannuation are proposed, followed by a scale of superannuation allowances. These range from fifteen-sixtieths of the average annual salary of the last five years of men
1. This resolution referred to the constituting of a district council. 2. That the Local Government Board should be the authority to which the administration of vaccination should be intrusted. 3. That failing the entire transference of administration from boards )f guardians to the Local Government Board it is absolutely necessary n the public interests that the public vaccinator should be as indeoendent in position as the vaccination officer. 4. That the minimum fees cannot be fairly reduced, and in many Jountry districts they are inadequate on account of the distance to be
755 covered, and that
an
additional minimum fee of ls. per mile should
paid for each journey over two miles for each mile or part of a mile. 5, 6, and 7. These resolved that school children should all be compelled to produce a certificate of successful vaccination; that there should be compulsory revaccination between the ages of 10 and 14
be
years; and that " successful" vaccination should be defined in any future legislation. 8. That in the public interests all the institutions for the provision’of calf vaccine in this country should be open to Government inspection and that no imported lymph should be used from any institution which is not recognised by the English Government. 9. That there should be a Government vaccination station for the
supply of lymph in
all numerous centres of population. 10. That " efficient vaccination should be denned as at present fixed by the Local Government Board as four insertions and half a square inch of cicatrix, and that the number of insertions and successful pustules be named in the certificate and registered by the vaccination officer. 11. That every medical practitioner not acting as public vaccinator who forwards a certificate to the vaccination officer of any efficient vaccination be paid a fee for the certificate, provided that such certificate states the number of insertions and successful pustules, and that such fee should not interfere with that charged for the operation.
Public Health LOCAL
and
Poor Law.
GOVERNMENT
BOARD.
REPORTS OF INSPECTORS OF THE MEDICAL DEPART1IENT OF THE LOCAL GOVERNMENT BOARD. .
On Epidemaie Small-pox in the Union of Ursett, 1901-02, by Dr. G. S. BUCHANAN. 4-The Union of Orsett, which has a population of some 33,000, is situated in South Essex and ext,ends from west to east about 14 miles and from north to south about seven miles, the Thames forming its southern boundary throughout. The most populous portions of the union are the riverside neighbourhoods between Purfleet on the west and Tilbury on the east. The town of Grays lies midway between Purfleet and Tilbury and forms the Grays urban district ; the rest of the union is comprised in the Orsett rural district. During the ten months from September, 1901, to June, 1902, small-pox appeared in 12 out of 17 parishes in Orsett rural district, the attacks per 1000 of the population in those parishes being 18’5; while in Grays urban district 16 per 1000 of the population suffered from the disease. The epidemic was thus of great severity. It may be contrasted with the London borough of Holborn which suffered most heavily during the recent outbreak in the metropolis, where the attacks of small-pox per 1000 during 11 months ending June, 1902, were no more than 7’2. Dr. Bu,;hanan gives tables showing the incidence of smallpox week by week on the population and on dwellings in various subdivisions of the union. The epidemic had its beginning (from September to November, 1901) among the small community of Pur fleet and in persons living elsewhere in the union where the attacks could be referred to infection from others who had contracted infection at Purfleet. From the middle of November, 1901, onwards the disease became prevalent over the whole of the southern portion of the union, its incidence being especially severe upon the villages of West Thurrock and South Stifford, which lie between Purfleet and Grays, and upon the parish of Aveley which adjoins Purfleet on the north. The report deals in detail with the condition of the population of the union at the beginning of the epidemic in regard to vaccination. Since 1891 neglect of infantile vaccination had increased and from 1895 to 1900 more than one-third of the children whose births were registered had not been vaccinated. With the exception of certain special communities (which entirely escaped small-pox) comparatively few persons of ten years of age or upwards were already revaccinated when the epidemic began. Having regard to the large number of unvaccinated children, it was fortunate that no instances occurred of the spread of small-pox in schools such as happened in Gloucester in 1896. Nevertheless, it is noteworthy that out of a total of 519 cases admitted to the local small-pox hospital no fewer than 100 were unvaccinated children under the age of ten years and that 22 of these children died. During the same period only ten vaccinated children under the age of ten years were admitted, each suffering from discrete small-pox, and no death occurred among them. An instructive table prepared from data obtained by Mr. Rea Corbet shows with regard
fatality from small-pox in the unvaccinated was much greater than in the primarily vaccinated and this, not only at ages from 10 to 25 years (unvaccinated rate 14. 3 per 100, primarily vaccinated rate 3’9), but also at ages over 25 years. 18 cases were admitted in which revaccination was stated to have been successfully performed at some period or other before infection by small-pox. In four cases this period was less than ten years, in one instance no more than six years. The progress of the epidemic caused a complete change in the attitude of the majority of the population towards vaccination. By March, 1902, as many as 6763 persons had been recently revaccinated and many children over one year. had been recently vaccinated by the public vaccinators, while a large amount of revaccination and vaccination was performed by medical practitioners who were not public vaccinators. No case of small-pox occurred among persons recencly revaccinated save those who were already incubating small-pox at the date of revaecination. The most striking facts of the epidemic, however, were the severe and long-continued prevalence of small-pox in Purfleet and the evidence obtained which referred small-pox in other parts of the union In this village to infection contracted in Purfleet. throughout the epidemic cases kept on occurring week after week and month after month ; altogether 41 out of the 110 dwellings in the place were affected. During the whole epidemic period in Purfleet and elsewhere there was no failure in the arrangements for isolation, cases of small-pox being removed within !i4 hours of notification ; 11 contacts were kept under observation ; and disinfection, on the whole, was satisfactory. There was little or no evidence that small-pox in Purfleet was maintained by undetected cases or by supposed chicken-pox. Moreover, revaccination in Purfleet was freely resorted to. On a liberal estimate those inhabitants who at the end of March, 1902, were not vaccinated children, revaccinated or recently vaccinated adults, cr persons who had suffered from smallNevertheless, cases of small-pox pox did not exceed 40. subsequently occurred among these 40, while other later cases in Purfleet were persons newly arrived in the place. These considerations, along with a number of others in the report which space does not allow us to summarise, are important in their bearing on the question of the convection of small-pox infection from the Metropolitan Asylums Board’s small-pox hospital ships which are moored in the Thames off the Kent shore, opposite Purfleet, from which they are by nearly half a mile of water. There was no personal communication between the ships and Purfleet throughout the epidemic and in considering the influence of the ships, as Dr. Buchanan puts it, we have to choose between aerial convection or nothing." to adults that the
"
separated
As to the latter alternative I would say at
once
that if the presence
of the small-pox ships in Long Reach had no concern with the Purfleet epidemic, then, while making every allowance for opportunities of local spread of the disease, I am nevertheless quite unable to suggest any reason for the extraordinarily heavy and long-sustained prevalence of small-pox there. If, on the other hand, the ships did exert influence on the epidemic, infective particles being from time to time, under favouring meteorological conditions, conveyed to the area of Purfleet and there reinforcing small-pox already prevalent, or setting small-pox going anew, then not only is the Purfleet experience intelligible, but the hypothesis invoked to explain it is one that has been shown to be necessary, in our present knowledge, if the characteristic peculiarities in the distribution of small-pox in the neighbourhood of small-pox hospitals are to receive anything approaching a suftictent explanation.
Those who are interested in the question will note with interest the abundance of circumstantial evidence given in the report that the ships were responsible for disseminating infection in their neighbourhood in the way in which the London hospitals of the Metropolitan Asylums Board used to do when they received acute cases of small-pox. Instances were traced, for example, in which members of the crew of vessels moored for a while in Long Reach sickened with small-pox about 12 days afterwards. It is, of course, impossible to test the matter in this case by looking for graduated intensity of incidence of small-pox in dwellings near the hospital ships ; there are, practically speaking, no dwellings within a mile of the ships save those in Purfieet and the Dartford marshes to the south of the ships are uninhabited. But during the period under consideration large numbers of workmen were employed opposite the ships on the Kent shore in the erection of temporary buildings and among these men cases of small-pox occurred almost by the Unlike the inhabitants of Purfleet these men may score. of "mediate"infection by associa1 London : Eyre and Spottiswoode, East Harding-street; Edinburgh have had opportunities tion undetected by the authorities with members of the Oliver and Boyd; Dublin: E. Ponsonby. Price 1s. 6d.