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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$been suggested that in children above the age of 10 or 12 years the effect of vaccination would have died out. and that a person certified as vaccinated would not enjoy the same protection as complete vaccination would give ?—I have no such information, I could do it below ten or below 15, but not below 12. The deaths are only taken out by certain periods, and 12 is not one of them. The figures in Table B suggest that the effect of vaccination dies out, because they show an increase of mortaUty from small-pox, after 15 years of age. 364. WUl you give the rate to the Commission from three months up to 10 years ?—I will do so by the next meeting of the Commission. {See Aiypentlix II., Table I) : ]page 114.) 365. Have you also made out a table showing the distribution as regards age of the vaccinated and un- vaccinated, who die from small-pox ?—Yes, I have ; and omitting, as before, all children under three months, that is, under the age of compulsory vaccination, and sepa- rating the deaths into what I will call unvaccinated and vacciuated deaths, and taking the unvaccinated deaths, I find that 60 per cent, of them were under the age of 15; consequently, if all persons were unvaccinated, 60 per cent, or thereabouts of the deaths from small-pox would be of persons over three months and under 15 years of age, this being the proportion among the un- vaccinated. But taking the vaccinated deaths, I find that only 13 per cent, were under 15 years of age ; so that it appears to me that there must have been something or other in the introduction of this practice of vaccination which has reduced the proportion under the age of 15 from 60 to 13 per cent. ; that vaccinated persons unci::- 15 are enjoying some greater protection than vaccinated persons above 15, and that this protection is not enjoyed by those who are unvaccinated. {The table was handed in. See Appendix II., Table E : page 114.) 366. That would give information of the same description as the return which I asked for just now ?— Yes, of the same character. 367. These figures would show that out of every 1,000 who died unvaccinated 597 were under the age of 15, and that out of every 1,000 who died vaccinated only 126 were under 15 years ?—Yes ; I said 60 per cent, in round numbers; it is 597 in 1,000. As regards the ages of the vaccinated and the unvaccinated respectively who die of small-pox, there is another point to which I would call attention, but which is not shown in that table, namely, the different proportion in the two cases of deaths in the first three months of life and in the next nine months among infants in the first year of life. Clearly, supposing vaccination to afford any pro- tection, children who are over the age of compulsory vaccination are in the aggregate more protected than children who are under the age of three months, because a large proportion of them will have been vaccinated, and that diilerence between the two ought to increase as vaccination becomes more and more stringent. There- fore I have looked to see whether that was the case, and I find that in the years from 1852 to 1860, 63 per cent, of the infantile deaths from small-pox were of infants over three months; from 1861 to 1870 the proportion had fallen to 57 per cent.; and then, taking the period from 1881 to 1887, it had fallen still further to 50 per cent. ; so that there is a progressive diminution in the proportion of infantile deaths from small-pox among those over three mouths of age ivho are getting more and more protection by the increasing stringency of vaccination. The numbers on which the calculation is based are not very large, so that I should not think the argument was of any great value ; still that is how the figures came out. 368. Is there any other point arising upon the sta- tistics to which you desire to call the attention of the Commission ?—I understand that you are excluding the question as to whether other diseases have increased owing to vaccination P 369. Yes ; that will be a later part of our inquii-y. I understand you to say that the general death rate has decreased as well as the general small-pox rate P—The general death rate has decreased 9 per cent., while the small-pox rate has decreased 72 per cent. 370. {Sir James Paget.) Would there be any material difference if you were to divide the period from 1854 to 1867 and from 1868 to 1880 ?—I am afraid I cannot answer that off-hand. You mean instead of taking- it from 1854 to 1871 I should think there would; because in 1871 there was a considerable outbreak, and that would be excluded from the earlier period. 371. Thac would afi'ect the question of the influence j^f^ of the alteration of the Act of 1867 ?—That Act was William Ogle comparatively inoperative ; it gave permission to boards j(f. ' of guardians to appoint vaccination officers, but appa- rently they did not comply mth it in a great number of 3 July 1889. cases. 372. The great contrast did not begin till 1872 P—It did not begin till the 'Act was passed in 1871, in con- sequence of the alarm created by the outbreak of disease ; and this Act came into force in 1872. 373. {Mr. Savory.) In the present state of the law with regard to vaccination, what children are exempted P —None, I believe. 374. But supposing a child was in ill-health P—A child who is certified by a medical man to be unfit for vaccination is of course not vaccinated P 375. At that time ?—-Yes, at that time. 376. That does happen ?—You will get that from the Local Government Board. The business at the office with which I am connected has ceased before that time ; our business as regards vaccination is simply to furnish the vaccination officers with a list of all children whose births are registered; after that we have dis- charged our duty, and the matter falls into the hands of the Local Government Board. 377. You could not tell, in fact, whether any childi-en escape vaccination altogether, or how many?—No, I cannot tell that except by the returns made every year by the Local Government Board, giving the number of births, the number of successful vaccinations, the ^.r of deaths, and the number of cases which are finally unaccounted for—that have gone away and dis- appeared. 378. Could you give the Commission any idea of that figure ?—I am afraid I could not; it difi'ers very largely in different parts. 379. Have you any information to give the Commis- sion upon the general practice ; is a child allowed to escape vaccination upon the ground of being dehcate, although without specific disease p—I am afraid that 1 cannot give you any sufficiently satisfactory answer to these questions, because it is outside my office, and I only know by hearsay. 380. I wish to ask you as to the distinction between typhus and typhoid: that distinction has been compara- tively recently made ?—Yes. 381. Before that, typhoid got included with typhus, did it not p—Yes. 382. So that the figures about typhus are not worth much ?—They are not worth much, but it is generally admitted that typhus has very much declined. 383. Still, up to that time there would be that con- fusion between the two; probably under typhus, typhoid would be included, and probably other fevers too ?—There was no attempt to separate them until the year 1869, 384. {Professor Foster.) You said that the death-rate in the later periods of life from small-pox had actually increased ?—Yes. 385. Is the increase great; do you know about how much it is P—Taking the ages from 15 to 25, the rate increased between the first and second of my three sub- periods from 109 in a million to 163 in a million, but since then it has gone down to 122. Taking the ages from 25 to 45, the rate rose from 66 to 131 ; and since has fallen to 107 ; finally, taking the ages from 46 years upwards, the rate rose from 2'A to 52; and then fell in the third of my sub-periods to 47 ; and you will notice that in the last period there has been a decline again. 386. It has not been a progressive increase P—No, in the third sub-period there has been a dechne, owing, as 1 beheve myself, but that is a matter of opinion, to the greater use of re-vaccination ; it has only occurred in the last few years. I made out a similar table to this some eight or nine years ago, and that showed a pro- gressive increase, but the addition of the new years to the table shows a fall at the later ages. 387. Is that shown upon your diagram ; do you give a curve for that ?—No. 388. Do many other diseases show a similar increase at the later agesp—There are several diseases which show an increase at the later uges, but none, that I am aware of, that show a similar (.lecline at the earliei ages and increase at the later ages.$