Volume 1
Reports of the Royal Commission appointed to inquire into the subject of Vaccination; with minutes of evidence and appendices / Vaccination Commission.
- Great Britain. Royal Commission on Vaccination
- Date:
- 1889-1897
Licence: Public Domain Mark
Credit: Reports of the Royal Commission appointed to inquire into the subject of Vaccination; with minutes of evidence and appendices / Vaccination Commission. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![Protective power of previous small-pox. Proximate Causes of the Epi- demic. many had not a score of pocks upon them; and during the earlier periods of the epidemic, when the people were not on the look out for the disease, some continued at work without any hesitation, and without any evil consequences to themselves. But some of the cases were of quite a different variety, being severe and the eruption on the face confluent. The proportion of sach cases was 21 per cent, among the vaccinated persons and 72 per cent, among the unvaccinated. Definitions of the three varieties of small-pox adopted—Mild, Discrete, and Oonj&uent—will be found on p. 23. There were numerous illustrations that a mild case may, by infection, give rise to a severe case, and vice versa. Thus, severe cases gave rise to the mild cases 6a, 2, 3, 30a, &c., and the trivial case, 30a, gave rise to the severe cases 31, 57, 98., 112, of whom the last two died—showing that, however wide the variation in severity, the disease is but one clinical entity. It happens that Warrington offers exceptional facilities for testing the truth of the proposition that one attach of small-pox generally confers a lifetime's immunity from a second attack, owing to the extensive prevalence of the disease in the town and its neighbourhood during this century (p. 41). I have not seen so many pock- marked people in one place since visiting Northern Africa, and I was not surprised at the estimation that about 1 • 6 per cent, of the inhabitants had previously suffered from the malady. This is doubtless owing to the position of the town of Warrington on the high road to and from Manchester, Liverpool, and other large towns in the north of England, where it constitutes a half-way house for a floating population, who take such a leading part in the spread of infectious disease. Out of the ()67 cases which constituted the Warrington epidemic 0*75 per cent, had been previously attacked with small-pox. It follows, therefore, that a previous attack does not confer absolute immunity, and, if the evidence I submit be correct, it tends to show that small-pox occurs about as frequently in persons protected by a previous attack of small-pox as it does in persons who have been vaccinated twice or oftener in their lives. The figures are not large, but much care has been taken to eliminate sources of error. As regards the immediate causes which lead to the outbreak, the evidence, in my opinion, seems to show that the three leading factors in the causation of the Warrington Epidemic, 1892-3, were, in the order in which they become apparent in the narrative (Part I.), as follows :— 1. Non-recognition of three of the earlier cases, viz., the 2nd, 3rd, and 4th persons who developed the small-pox eruption, in August. They were seen by a doctor's assistant (alleged to be unqualified) acting in the absence of his principal. Two of them, though apparently well-marked types of small-pox, were treated at home by him as German measles for 10 and 7 days respectively ; meanwhile the visits of friends and neighbours were unrestricted; and their relatives went to work as usual, or played daily with other children in the adjacent streets or open spaces back-and front of the houses in that row. Finally the Medical Officer of Health, hearing rumours of these cases, visited them and they were promptly removed to hospital, where one of them, the unvaccinated child, set. 10, died three days later. Three of the children of the older case contracted the disease, and altogether 23 cases resulted in their immediate neighbourhood (Narrative, p. 9). The third unrecognised case was a mild one and altogether escaped detection and isolation. This man gave the disease to his wife and an indefinite number of other persons. 2. Deficient Hospital accommodation for the isolation of sma]l-pox and other infectious diseases. Sixty-four beds represent the minimum requirements of the Borough of Warrington based on the number of cases of infectious diseases needing isolation which have actually arisen and were notified in the community during the four years 1889- 1892 ; and the total provision at the commencement of the epidemic was 30 beds for all diseases, or less than half the very lowest estimate (page 63). As a consequence of this only 13 cases of small-pox could be received into the Borough Eever Hospital by dangerously overcrowding every available space. The cases therefore, about 60 in number, which arose between August 25th and September 19th, when additional tem- porary hospital provision was made, were of necessity left in their own homes scattered over the town. Consequently the town became so saturated with infection, and the eases arose so rapidly that the limit of hospital accommodation, even with the addi- tional 159 beds crowded into the temporary hospital, was, for a second time, reached](https://iiif.wellcomecollection.org/image/b21363717_0001_0032.jp2/full/800%2C/0/default.jpg)
