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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$334. I believe the Local Government Board annually publish the percentage of successful vaccinations to bii'tlis ?—Yes. 335. But you cannot tell me whether you think it has increased since the Act of 1871 ?—I cannot say. May I mention that I have understood you to mean '' success- hil vaccinations as opposed to unsuccessful ? 336. No, I mean successful vaccinations as compared to not being vaccinated at all —That is to be found in the reports of the Local Government Board 337. But you have not the figures here ?- the figiires here at command. -I have not The witness withdrew. Sir John Simon, K.C.B. 3 July 1889. Mr. William Ogle, M.D., examined. 388. {Chairman.) Are you the Siiperintendent of Statistics in the office of the Eegistrar-General ?— Yes. 339. How long have you held that position ?—Nearly ten years. 340. What data exist for comparing the small-po.'s mortality in imvaccinated times with that of the present day?—There are no very perfect data, because pre- viously to this century we have no knowledge of the population, and no accurate knowledge of the )iumber of deaths ; so that it is impossible to calculate a death- rate. But you have some indications of an inferior kind, by comparing the proportion of deaths from small-pox to the deaths from all causes in previous centui'ies, and in the present day. We have not got the facts for England, but Ave have the bills of mortality for London, which tell us for two centuries past what were the number of burials from cases of small-pox. and what were the number of burials from deaths of all kinds. Sil. Have yoii made any statement of the result of such comparisons ?—I have taken as a basis for com- parison, the 10 years from 1871 to 1880, which are the years which include the great outbreali in London in 1870-71, so that those years represent a time when small-pox was particularly abundant in Loudon. Taking those 10 j^ears, I find that, in round numbers, the small-pox deaths were 20 in 1,000, from all causes. I then go back 100 years to the corresponding decennium in the 18th century, 1771-80, and I find that the small-pox deaths were then 97 in 1,000. Then going back another 100 years, 1671-80, I find the proportion was 66 in 1,000 ; so that in the present century small- pox, as measured by its proportion of deaths to deaths from all causes, has been from three to five times less common than it was in those previous times ; and it is plain that if the death-rate of the 18th century and the death rate of the 17th century was higher than it is now, small-pox miist have been very much more number was 1,015 deaths per million ?- the same as in 1838. -It was practically il/r. William Ogle, M.D. 347. In 1872 there were 824 deaths to a million living. I see since that date the highest year down to 1877 has been 178 ?—Yes. The table deals with 46 years, and if you divide it equally into an earlier and a later period of 23 years each, you will find a very marked difference. In the first 23 years the rate was only twice under 100, whereas in the second 23 years it was 12 times under 100. In the first 23 years there were only five occasions when the rate Avas under 150, whilst in the second 23 years it was 19 times under 150. 348. In the last 15 years, that is, from 1872 to 1887, the rate has never been higher than 178 ?—That is so. I should say that the figures include chicken-pox as well as small-pox. It was necessary, in order to make the comparison fair, to include chicken-pox, to which a certain number of deaths are attributed every year. It was impossible to separate them in the earlier years, consequently they have been added in the later years, Avhich makes the figures a little higher than those given for small-pox in the Eegistrar-General's Annual Eeports. 349. One hundred and seventy-eight is the highest in the 15 years beginning Avith 1873; that is to say, after the tAvo years of epidemic; and then if jou take the 15 years before, it Avas in six cases out of the 15 years higher than 178 ?—I Avould, hoAvever, divide the years in a difi'erent way. Instead of dividing them into portions of 10 or 15 years, or periods simply deter- mined by their length, I would divide them by the changes in the vaccination laAvs, into periods or sub- periods corresponding with the difi'erent vaccination enactments. I Avould divide them in that Avay into three sub-periods : the first from 1838 to 1853, inclu- sively, the period during which vaccination Avas'purely optional ; then a second sub-period, from 1854 to 1871, inclusively, in which vaccination was nominally com- prevalent, because a larger proportion of a larger P]sory, but Avhen there were no effectual means of - - - - enforcing the obligation; for though there Avere in some cases vaccination officers, their appointment by boards of guardians Avas not compulsory, and these bodies neglected, very commonly, to do their duty. 350. [Mr. Ficton.) Do you object to 1868 instead of 1871 ?—Yes ; 1868 Avas the year when permission was granted to boards of guardians to appoint vaccination officers, but they did not appoint them, as I believe, except in rare cases. In 1872, the Act having been passed in 1871, it became obligatory on the part of boards of guardians to appoint vaccination officers; and consequently from that date I take the third period, of comparatively strictly enforced A'accination. Taking these three periods, purely optional vaccination, vac- cination nominally compulsory, and vaccination com- pulsory and efficiently enforced, I find the small-pox death-rate in the first period Avas -i 08 per million,, in the second period it was 223 per million, and in the third period, from 1872 to 1887, it was 114 per million, shoAving a marked and progressive decline, coinciding in time with the changes in the vaccination laAvs. The decline in the Avhole time has been about 72 per cent. 351. {Chairman.) You have given the Committee the decline in the deaths from small-pox in the later periods as compared Avith the first, and with each other, is there any evidence to shoAV, beyond the fact of the decline and the alteration in the vaccination laAvs Avith the vicAv of making vaccination more effective, that the decrease Avas due to vaccination and not to other causes, such as improved sanitary regulations ?—I think there is such evidence. There are statistical facts which it appears to me impossible to explain on any other hypothesis than that the decline Avas due to vaccina- tion. Notably this comes out, T tliink, if instead of taking the change in the aggregate deatli-rate irom number of deaths occurred from it. Of course it is only an assumption, but an almost certainly true assumption, that the death rate was higher in the 17th and 18th centuries than it is noAV. 342. Since 1837, that is to say, for the last 50 years and upwards, we have accurate statistics ?—You have more accurate statistics since the General Register Office was instituted and a civil register begun, which was in 1837 ; and from that date we have the small-pox deaths and the sm;ill-pox death-rate in proportion to the popu- lation, for each year, with the exception of four years, in Avhich there is a gap; but for those 50 years, or rather 46 years out of those 50 years, Ave have fairly accurate returns of the small-pox mortality. 343. What was the cause of the void of the four years ?—I cannot tell you; but for four years the causes of death Avere not abstracted. It is a long time ago. I presume the staff Avas not sufficient for the pui-pose. 344. Were those four years consecutive years ?—Yes, they Avere consecutive years. The missing years Avere 1843, 1844, 1845, and 1846. I have a table here Avhich gives the figures in a tabular form, and also in the form of a diagram. The table gives the annual deaths from small- pox per million living in England and Wales, and the diagram gives the same in a diagrammatic form. {The diacjram and table were handed in. See Appendix II., TaUe A : page 114.) 345. The table begins with 1838, when there were 1,064 deaths per million ?—Yes, per million living. The table shoAvs great fluctuations, and very irregular fluctuations. 346. In 1871 it reached nearly as high a level as in 1838; that was the year of the epidemic, when the$