First (-Second) report of the Royal Commission appointed to inquire into the subject of vaccination; with minutes of evidence and appendices.

Great Britain. Royal Commission on Vaccination

Date:: 1889-1890

Credit: First (-Second) report of the Royal Commission appointed to inquire into the subject of vaccination; with minutes of evidence and appendices. 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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$there is tbis passage:—It is probable that a larger proportion of iinyaccinated persons is to be found among the ignorant, dirty, and wretched inhabitants of the slums of London, and very few indeed among the educated and better-fed members of society. The disease is much intensified liy overcrowding. Do you think that would be a just criticism P—I do not think that overcrowding has anything to do with starting small-pox, but it will extend small-pox. 1842. Do I rightly understand that the unvaccinated are, as a rule, drawn from a more neglected class than the vaccinated?—I should think certainly from a poorer class. 1843. Do you consider that that is likely to operate detrimentally by way of raising the unvaccinated mortality p—Undoubtedly I think so. 1844. With regard to the relationship of smal]-pox to insanitary conditions you were going to give us your opinion ; will you kindly continue your statement ?—I was simply going to say that I do not believe that any insanitary condition would start small-pox. 1845. I have before me your report for the year 1875 in which you say :— To the prevalence of overcrowding, which must almost of necessity exist in large cities, can be attributed the cause and extension of infec- tious diseases; and until the time arrives when the removal becomes legally compulsory of those who by '• contact can spread a disease, little hope can be cnterta-neJ of warding off, except for a time, epide- mics of greater or lesser magnitude.' Apparently you suggest there that overcrowding, &c. can cause and extend infectious diseases like small-pox P—I think overcrowding undoubtedly extends an epidemic of any kind whether it is small-pox or fever; but I do not think it sets it going. 1846. I think you gave evidence before the Royal Cominission with regard to infectious hospitals ?—I did. 1847. And you have also suggested valuable methods of conveying small-pox patients by water, and so on ?— Yes. 1848. Could you give us your view as to thg effect which you think could be produced in Lonaon as regards the limitation of small-pox epidemics by careful isolation?—I think the action of the Metropolitan Asylums Board has exemplified that in the most marked degree. The number of small-pox patients that have been removed in the last two years is simply marvellous, almost entirely owing, 1 believe, to the immediate isolation in each case. 1849. To revert once again to your tables, I under- stood you to say that while the majority of the cases admitted to the hospital were vaccinated a large majority of those vaccinated cases were vaccinated by public vaccinators ?—My inference would be that they were. Of course I do not know whether they were vaccinated hj private practitioners or by public vacci- nators, but being collected from the absolutely pauper class and coming in under relieving officers' orders, I imagine that they would be vaccinated by public vaccinators. 1850. {Chairman.) Would that apply equally to those who came in whether vaccinated or unvaccinated ?— Yes, they were all absolutely paupers. It is only within the last year or two that patients have been ad- mitted under any other circumstances. 1851. (Dr. Collins.) Do I correctly understand that it is the practice at public vaccination stations, where you presume that the majority of these persons were vaccinated, to carry on the vaccination from arm to arm ?—I take it that it is so now, but I do not think it was so 20 years ago. 1852. Not in 1871 P—I do not think so. I think there was very often a dearth of vaccine then. 1853. As to the mortality of hospital small-pox for- merly, do you think there is any reason to doubt the accuracy of the statement that hospital small-pox before this century gave a mortality of 18 per cent. ?— No, I do not know that there is any reason to doubt the correctness of the statement. 1854. Have you formed any judgment in your own mind which would explain the reason why, with the large diluting effect of vaccination, as many as 80 per The witne cent, of small-pox cases being vaccinated, the mortality Mr. William. remains at about 18 per cent, now?—Nc, I do not Gai/ton, M.J). know of any explanation that I can give, except that the unvaccinated and the badly vaccinated produced the 16 Oct. 1889. larger share of the admissions. 1855. Natural small-pox, ^is you term it, apparently now gives a mortality of 46 per cent. P—Yes, something like that. 1856. But natural small-pox in the last century ap- parently gave a mortality of 18 per cent.; you have no explanation to offer as to that ?—No. 1857. {Chairman.^ You have said that, including in the vaccinated those who were said to be vaccinated, but as to whose vaccination there was no visible evi- dence, eight out of ten admitted to hospital would be vaccinated; supposing the statistics of the proportion of vaccinated to unvaccinated were to be anything like correct, the eight vaccinated would have been drawn from a larger proportional population than the two un- vaccinated p—Very much larger. 1858. I see, if the addition that I have made is correct, that including in the vaccinated admitted up to the age of five all those who were said to be vacci- nated there were 319, whilst of those unvaccinated there were 677 P—Yes, I believe that is correct. 1859. If it be the case that the 677 were drawn from 5 per cent, only of the population, there ought to have been out of the other 95 per cent, a number enormously greater than 319 if they wore attacked in an equal pro- portion?—Yes, that would be so. 1860. {Sir James Paget.) In regard to the abiding influence of vaccination, up to what you call advanced age, say after the age of 40, I find by your tables that after the age of 40 among those with good vaccination there were 48 cases ?—Yes. 1861. After the age of 40 in the unvaccinated there were 79 cases ?—Yes. 1862. Therefore there were 48 on one side and 79 on the other; I suppose we may take the proportion of 90 per cent, as vaccinated; if so, the 90 per cent, after the age of 40 had yielded only 48 cases, and the 10 per cent, after the age of 40 had yielded 79 cases P—Yes. 1863. Does that imply an abiding influence even after the age of 40 ?—I think so. 1864. Those are the good vaccinations. Of the good and the imperfect vaccinations there were 314 cases after the age of 40, and of the doubtful and not vaccinated there were 210; therefore there was a much larger proportion of cases after the age of 40 in the doubtful and unvaccinated than in the im- perfect and good vaccinations ?—Yes, showing that the vaccination was still keeping up a considerable amount of protection. 1865. {Mr. Hutchinson.) I suppose you are an advo- cate for the repetition of vaccination ?—Certainly. 1866. Supposing that vaccination were carefully re- peated once every 15 years of an individual's life throughout the whole population, what should you suppose would be the efi'ect upon the prevalence of small-pox ?—It would reduce it most materially. 1867. Do you think that it would practically exter- minate it ?—I am afraid my experience is not sufficient to enable me to answer that question. 1868. You think it would go a long way in that direc- tion P—It would go a long way in that direction, I have no doubt. 1869. I suppose yon quite allow for the wearing out of the cicatrices in good vaccination, and you believe that would be difierent in different individuals P—Yes ; I knew a case of a man of 70 who was brought to hos- pital with small-pox, who had a typical cicatrix from infancy. 1870. Is not that very exceptional P—Yes. 1871. The original vaccination may have been very good in many cases, and the cicatrix may have worn out ?—Yes ; the numljer of cases after 30 or 40 years of age are very few. 1872. Supposing the vaccination to have been re- corded as satisfactory, is not the interval between the vaccination and the attack of more importance than the visibility of the cicatrix P—I think so. 1 withdrew. o 60238. E$