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
Licence: Public Domain Mark
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.
185/520 (page 27)
![like to see; they are not selected, they are taken out of the great collection that was sent to me ; the returns mount up, I think, to over 60,000 and weighed some- thing like half a ton. These will be sufficient to show how the returns were made to me. Wherever there had been small-pox there was a blue cross put on the page, and of any house in which there was a sniall-pox death you will also find an entry of the fact. 1889. Take this first one, North Sheffield, Nether- thorpe Street, No. 13. Occupier, Dan Brewin. No entry; what would that mean ?—That would be an unoccupied house ; each man has a different system of making his entries. 1890. Where you find under Vaccination, Yes, would that represent the form of answer given by the parent?—By the parent or householder. 1891. (Mr. Whithread.) No information, does that mean refused information ?—Refused. 1892. Were there many cases in which information was refused ?—At page 169 of my report it is stated that Information was altogether refused to the enumerators by the inmates of 764 houses; details of one sort or another were refused in 118 instances ; those were mostly cases of maiden ladies who did not like to tell their age. 1893. Were the refusals to supply information at all localised or were they spread over the whole town ?—My impression is that the largest number were in the Ecclesall district; there were 226 in the Ecclesall dis- trict. There was another district where I believe there were a number of refusals. In Ecclesall there were several refusals from people who lived in higher class houses. 1894. Generally speaking, were the refusals from people who lived in the better class houses or from poor people ?—Certainly not from poor people ; they were from people in the better class of houses, as a rule. I had better now say something as to how the corrections were made on these returns that came in. These returns are given in the report, and an analysis of them is also added with the following corrections : they are corrected as regards the deaths from my own personal inquiry as to whether the people were vac- cinated or unvaccinated; they are corrected also with regard to children under 10 years of age who were reported at the census to have been vaccinated and to have had small-pox ; every such case was personally inspected that could be found. 1895. (Chairman.) By corrected you mean re- vised ?—Yes, or verified. They might have been cor- rected in some cases. 1896. Revised probably would be the better term to use .P—Yes. By verified I mean that where a child under 10 years of age attacked by small-pox was reported to have been vaccinated, I inspected the child, and if I found that it was unvaccinated, though entered by the enumerator as vaccinated, it was finally re- turned in the analysis as unvaccinated. When the returns were being analysed a list was made of every child under 10 years of age who was said to be vacci- nated, and to have had small-pox ; every one of these cases that was living was personally examined. I have got a couple of these lists here for the West Sheffield district. This one (showing a list) will be found to cor- respond with the first part of Table LVI. on page 110 of my report. This is how it came to me from my clerk. Then, at the same time, a list of all cases that were stated to have had small-pox after re-vaccination, or were stated to have had small-pox after a previous attack of small- pox, were also extracted as special cases. This other such list is for the West Sheffield district, and the list to which it corresponds will be found in Table LX. on page 116. These special cases were personally revised in exactly the same way as the cases of vaccinated children under 10 years of age. Then there is another correction. Any child who had died under one month of age was not included in the deaths ; that is, anv un- vaccinated child under one month of age who had died of small-pox was excluded from the calculations. Most of these corrections are noted here on page 17. 1897. Why did you exclude children under one month? Was it because you presumed that none would have been vaccinated before that age ?—I excluded them because most of them had small-pox when they were born, and it would not have been fair to count them as unvaccinated children, as if they had acquired small-pnx afterwards. 1898. (Sir James Paget.) You have not entered them Mr. F. W. as deaths from small-pox?—They are not entered in Barry, M.D. the census calculations and comparisons, they appear in the general mortality statistics. Then there was 16 Oct. 1889. another correction made in the analysis of the facts respecting invaded houses,. That correction was this : any child, whether vaccinated or unvaccinated, which was born three months after the last case of small- pox occurred in the house was not counted as an inmate,—it could not be said to have lived in an invaded house, since the house was not infected at the time of its birth or afterwards ; the number of these infants is very small, but if the Commission wish to have them I can give the figures for each district, that is to say, the numbers that were subtracted from the inmates of in- vaded houses. I think those are the main points to which I need call attention with regard to the census. Then the second source of information was the official registers kept by the vaccination officers. Very shortly after my arrival in Sheffield early in January, I had an analysis made of the whole of the registers for the ])revious 10 years, so as to ascertain as nearly as possible the amount of default there had been in the vaccination in the Sheffield and Ecclesall unions. The summaiy table of the vaccination registers for 10 years with regard to the whole borough is given on page 185, viz., Table XCVII. Then there was another source of information, a quite distinct source of information from the census; this was the records that were kept at the Health Office of all new cases of small-pox that were reported; these were kept in a particular form, and I have here abstracts of the whole of the cases reported to the health office with certain particulars; there is the name and address, the age, whether vaccinated or not, and where treated, and the result. There is another particular entered on these lists, that is the exact position that the house in which the affected person lived bore to the Winter Street Hospital. 1899. (Chairman.) How were these particulars ob- tained ; were they notified by the medical men attend- ing the case, or in what way were they obtained ?— There is a system of voluntary notification in Sheffield, there is no system of compulsory notification ; there is a fee of 2s. Qd. paid to medical men for notifying certain cases of infectious diseases. A considerable number of medical men in Sheffield did notify cases of small-pox ; but the records at the Health Office also depended upon the reports of inspectors of nuisances and the information of private people. These (showing lists) are the abstracts of the health office records for the different districts week by week. I may say that where there is no entry under the head of Vaccinated or not, Vaccinated is the proper word to insert. I got tired of writing the word so often. 1900. Then besides the sources that you have de- Bcribed to us, were personal inquiries made p—Yes. I made personal inquiries, and when I say I, I should wish it to be understood that my colleague. Dr. Bruce Low, who was with me for a short time, made some of the inquiries. We made personal inquiry with regard, first of all, as I have already said, to every child under 10 years of age who was reported to have had small- pox after vaccination. Then I also made inquiry with regard to the quality of the vaccination performed by public and private vaccinators respectively. That in- quiry as to quality was on the lines of the local govern- ment inspections ; we have very strict rules laid down for our inspections for the parliamentary grant (the sum of money granted to the public vaccinators); and my examination with regard to the quality of the vaccination was made in reference to the standard therein adopted, namely, that the cicatrix should be well foveated, with well-defined margins, and that the aggregate area of the scars should be equal to half a square inch. You will find that the measurements of the scars are given in all the cases where I examined them ; and those measurements are not rule-of-thumb measurements, they are done with an instrument which I have here (showing instrument) and which we use for the purpose. The scars were all of them measured except where they were veiy large, where they were obviously over the required measurement. Then I al^o made an inquiry with regard to every death from small-pox whether in vaccinated or unvaccinated persons. Now with regard to the latter class of inquiry I may say that when I first went to Sheffield I got information from the every day sources. I got information from the doctors who had attended the cases, and from the registrars, and from the registers, and so on, and up to the end of May I accepted that information as sufficient for my pur- poses. But on Jane the Ist there was a debate in the E 2](https://iiif.wellcomecollection.org/image/b21361332_0185.jp2/full/800%2C/0/default.jpg)
