204.
Out of the total number of case eighty-four had previously been vaccinated, of these four died-a mortality of 3-36 per cent.-of the remaining twenty-seven cases nineteen died-a mortality of 70-37 per cent.-in three of the latter series it could not be ascertained whether the patient had been vacci- nated or not as they were suffering from the "hæmorrhagic" variety of the disease: excluding these cases, we still have sixteen deaths out of twenty-four unvaccinated cases or a mortality of 66·6 per cent.
Conclusions drawn from such a small number of cases are necessarily more or less fallacious, but the difference is sufficiently striking to demonstrate the extraordinary modification of the disease induced by the protective influence of previous vaccination, and "It may be laid down as a fact ad- mitting of no question, that whenever Small-pox attacks a community the unvaccinated portion of that community will suffer in enormously greater proportion than the vaccinated." *
Treatment:-With regard to the prevention of pitting by the use of local remedies, nothing of course has been found of any avail where the primary inflammation has been intense enough to cause sloughing of the bed of the pock; but much of the eventual deformity is caused by the ulceration and erosion of the skin which goes on under the scabs.
The constant application of antiseptic oils will check the formation of pus under the crusts and in this way prevent the ulceration and subsequent pitting.
A mask of lint kept constantly on the skin, and moistened two or three times daily with carbolic oil (1 in 20) has given very good results. It is applied when the rash is maturing and in many cases after five or six days the scabs have peeled off leaving a slightly red rough surface with little or no loss of substance. Only two cases were sent away with deep pits, and the majority are marked no more than after a slight attack of Impetigo or Varicella.
As I understand the question of the site of the Hospital for Infectious Diseases is still sub judice I would take this opportunity of referring to the suggestion I made in my letter of 14th December, 1887, (C.S.O. No. 2797/89).
In that letter I advised that a hulk or disused man-of-war be fitted up for the treatment of such cases as was done in London the Castalia being so fitted up during the Small-pox Epidemic of 1884. I certainly think that this scheme presents many advantages over erecting a large Hospital on the Island of Hongkong, it would not involve such a large expenditure more perfect isolation would be ensured, it would also be more advantageous to the patients on account of the greater coolness, &c.
If such could be obtained the present Small-pox Hospital premises after a little alteration might be used as Receptive wards where all cases of Infectious Disease might be taken to for purposes of observation before transferring them to the Hulk, as many of these diseases are very obscure in their
onset.
The hulk would require to be large enough to contain some sixty beds.
* Memo: on influence of vaccination in the prevention and diminution of mortality from Small-pox.-By Ernest Hart.
Year.
Number of examinations.
Enclosure 2.
Lock Hospital's Returns.
SYPHILIS.
Primary.
And Cutane-
Hard
Ous
Chancre Erup-
1886.
12,407
155 51
2
1887.
11,496
28 42
1888.
10,924
1
333
13
42
1
tion.
:
:
1
4 33
378 12,029
3
2
21
I
REMARKS.
129 11,367
5 Women were found disea- sed, but were treated outside the Hospital by
me.
h
2
· 18
1
66 10,853
Pa. В. C. AYRES, Colonial Surgeon,