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.

186/520 (page 28)

$Mr. F. W. House of Commons on vaccination, when it was Jiarry, M.D. annoiinccd that particular inquiry was beinc; made into each of these deaths; and a letter appeared in 16 Oct. 1889. one of the Yorkshire paper.? very shortly afterwards, written by a gentleman whom I knew to be very strongly opposed to vaccination, v.\ which it was stated that there was grave objection to accepting informa- tion from medical men, and that the information would be very much more trustworthy if it was obtained from the nearest relative, and that informa- tion from such relative ought to be accepted as final on the question of vaccinated or nob vaccinated. J t was also suggested that it was very desirable to know the reason why persons were unvaccinated—why they had never been vaccinated. i''nrther, it was alleged that without doubt in a large number of fatal attacks the previous health in the case of the unvaccinated would be found on inquiry to have been very much worse than the previous health in the case of the vaccinated. I at once saw the value of these suggestions, and I deter- mined forthwith to make inquiry as full as possible with regard to every death, and to ascertain from the nearest relatives the facts, and to accept the facts they gave me. I had these cards printed. {A ca-'-d was handed in. See Ap2]endix IV., page 248). We used these cards for entering every case as we inquired into it. I have a number of sample cards here. You will see how they are filled up and the particulars that were obtained. 1901. If successful state number of scars; was that left to the relatives ?—^Yes. They were pei'sonally questioned as to that; but their mere word was not taken as to area, or anything of that kind. 1902. In some of these cases the relatives must have had the assistance of the doctor in filling them up ?— Possibly one or two were filled up by help of the doctor. 1903. I should think this was : Character of small- pox—hsemorrhagic ?—That would be my filling up. After they had told me the character of the disease I should fill that up. I myself made the inquiry, and they gave me the description of the disease in each case. 1904. If successful state number of scars ; would you make an examination of the scars yourself?—No, the pei'sons were dead :—I would show the relatives the instrument which I now hold in my hand, and say, How big were they ; were they as big as No. 3 ? and they would say. They were as large as No. I, perhaps ; and they would be so entered on the cards. But no use has been made of that information at all; I did not think it was worth reporting on. Then, in addition to the information which we obtained with regard to the deaths, there was a separate inquir}' made with regard to every one of the persons who were stated to have had small-pox after re-vaccination. There were three sources of our information as to re-vaccinated persons. We had our census. I have shown you a list of special cases extracted from the returns. Secondly, very soon after getting to Sheffield, I put a letter in the various newspapers in circulation in the district asking to be furnished with the names and addresses of all persons attacked with small-pox after re-vaccina- tion. I also wrote to each doctor in Sheffield a letter, of which I have a copy here, asking for information as to any cases of small-pox observed by him after re-vaccination. Any cases that were reported from any of these sources were examined by me personally, and an account of them with their initials and addresses is given in the report. All cases of second attacks of small-pox were dealt with in the same way. Then the source of infection was traced as far as possible in early cases. It was impossible to trace it after the small-pox began to spread epidemically ; but in early cases the sources of infection were traced as far as possible, including many cases that occurred near the Winter Street Hospital. Then I personally inspected, in the manner in which we always do inspect in any sanitary inquiry that we are holding, the sanitary cir- cumstances of Sheffield itself. I examined into the drainage and water supply, the excrement disposal, the condition of the dwellings, and the crowding of the dwellings That ends the personal socrces of informa- tion, but there are still some other sources. 1905. There are certain registers I understand from which information was obtained?—Yes, in connexion with the hospitals there are certain registers—the hospital registers. Abstracts were made from them with regard to the type of disease in relation to vac- cination, [i think, perhaps, it maybe convenient at thi moiuei) t to state that I find a rather important error in one of the tables. Table CXII., on page 207. It is stated in that table that at the Borough Hospital in Winter Street two re-vaccinated cases only were admitted, and that those had the mildest type of the disease. As a matter of fact, three re-vaccinated per- sons were admitted and one of them died; the only death that we could ascertain of a re-vaccinated person in Sheffield. It ought therefore to be three re-vac- cinated and one death ; then you must take one otf the 71 in the next line; it would be 70 deaths among the vaccinated.! Then there were the mortality registers ; the tables ihat are given in my report on pages 226 and 227; namely, the tables of general and special mortality that occurred during 27 years in the borough of Sheffield. These statistics for the years 1861 to 1870 were obtained from registers that had been compiled by the superintendent registrars of the Sheffield and Ecclesall Bierlow Districts for the use of the town council ; those registers are deposited in the Free Library at Sheffield. From 1871 to 1886 inclusive, the statistics are obtained from the Registrar-General's annual summaries, and for 1887 from the weekly returns furnished to the Medical Officer of Health. The particulars in the large number of tables that follow CXX., on pages 230 to 247, are obtained for 1861 to 1870 from the town council registers, and from 1871 to 1887 from the quarterly returns of the Kegis- trar-General. Then the particulars as to age at death from various diseases, which are given on pages 258 to 264, were obtained for the first series of years, from 1861 to 1870, also from the town council's regis- ters ; and for the second 10 years, from 1876 to 1883, and for 1886 and 1887, they were taken from books which they call the Disease Register Books in the Sheffield Health Office. There are two years break—1884 and 1885—in which two years the books were not kept, consequently the data could not be got. The re- turns for the district of Upper Hallam were all made out for me by the superintendent registrar of the district. 1906. Does that cover all that you have to say with regard to your sources of information?—I think that gives every source of information. 1907. We will turn next to the results of the inquiry so far as they are connected with the question with which this Commission has to deal p—The inquiry took account of all the nine sub-districts of Sheffield, and treated them each as a separate dist.rict, so that we might compare any diflerences that there might be in sanitary circumstances or the housing or status of the population, in order tc ascertain how far these had any influence on the epidemic. The object that I had in view in dividing them in this way was to find out whether any one circumstance had a dominating influence on the epidemic. I have prepared here a map of Sheffield showing the divisions of the districts on a very much larger scale than any map in my report; it gives a very much better notion of tho position of the inhabited parts of the borough than the smaller maps that are attached to my report. (The map was handed in. See Appendix IV., facing page 248.) You will see on looking at this map that there are four districts known as North, West, South, and Park ; these form the old township of Sheffield, and that is the oldest part of the borough. On the map that I have handed in I have marked those particular parts of the town where the dwellings are very much crowded together, where the largest amount of crowding has taken place. You will find on referring to page 219 that, as regards North Sheffield, I state that it is the most densely and uniformly populated area within the borough, the density at the census of 1881 being at tho rate of 273 persons per acre. The sub-district lies generally on a steeja incline sloping to the north-east, east, and south-east. The most thickly-inhabited part of this district is a tri- angle bounded on the south by Broad Lane (that is the division between the North and West districts), on the west by St. Philip's Road, and on the east by the road traversed by the Sheffield and Hillsborough Tramway line. The houses in that area are almost exclusively occupied by the working classes, a great many of them being unfurnished with any means for through ventila- tion. Then in West Sheffield there is a similar area which is densely populated ; that area may be said to lie between Broad Lane and Tenter Street on the one side, and Portobello Street, TrippeLt Lane, andCamiDO Lane on the other. That part includes a number of the old crofts, which are extremely crowded places with very insufficient ventilation of the houses. Then in South Sheffield there is also a crowded area; that$