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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$to see whether there is any age-shifting in typhoid as there is in small-pox ?—No, I have not the figui-es. The great mass of the deaths from fever are from typhoid, and I have not the slightest doubt that had I the figures for typhoid separately the same result would come out as comes out for fever altogether. 513. I find that from 1871 to 1875 there were 43,769 deaths from typhoid of which number 7,617 or 17'4 per cent, were tinder 5 years of age; whereas from 1881 to 1885 there were 28,788 deaths from typhoid, of which only 2,678 or 9 3 per cent, were under 5 years of age. That would show a tendency less marked, but in the same direction ?—Yes. Do you find that there is any age in which there is an increase ? 514. In the absence of figures for the estimated population at different ages one is unable to get that ? —Without the population, how did you get your rates ? 515. The figures are given in the reports and show the percentage of deaths ? — I misunderstood your figures. I thought you were quoting rates. The figures you give show doubtlessly that the decline was greater among children than it was at other ages. 516. At page xxiii. of the 42nd report of the Eegistrar-General, he says : '' That the sanitary elibrts made of late years should have more distinctly affected the mortality of the young is only what might be naturally anticipated; for it is against noxious influences to which the young are more especially sensitive that the weapons of sanitary reformers have been chiefly directed. That shows the great importance of the question of age-shifting, and of comparing zymotic diseases rather than the total death-rate, does it not ?—Quite so. I said before, I think, that zymotic diseases were the better ones to compare small-pox with. 517. But you have not compared it with the zymotic diseases ?—Yes, I have. 518. Not in this Table L. ?—But here I give them you for fever, which is the main one. It is impossible to make similar comparisons in the case of scarlet fever or measles, and diseases that only affect children. Fever is the only one of the zymotic headings that you can take, because it is the only one that affects all ages to any extent. Fever is, therefore, the only one which it is possible to subject to this kind of investigation, and I have done it for that. 519. With regard to the decline oE scarlet fever, you told us that you attribute that chiefly to the fact that the majority of deaths from scarlet fever now occur in hospitals ?—Of course that is hardly a statistical matter, hut incidentally I stated that in the last five years there had been a very marked decline of scarlet fever simulta- neously with an enormous increase in the use of means of isolation ; and I put those two things together. 520. Very properly, no doubt. Could you give us the percentage of deaths from small-pox which take place in hospitals ?—No. 521. That could be similarly obtained, of course ?— For London it could ; it could be got, of course, by means of the hospital returns. 522. But I take it that similar isolation precautions have been adopted in the case of small-pox as have been adopted in the case of scarlet fever?—In the absence of figures I am unable to say whether there has been the same increase. In 1878, 7 per cent, of the deaths from scarlet fever in London occurred in public hospitals. The proportion rose year by year until in 1888 it reached 43'4 per cent. I do not expect that there has been any increase at all analogous to that in the case of small-pox, but there may have been. 523. Do not the same Metropolitan Asylums Board hospitals which take in scarlet fever take in small-pox ? —There are hospitals that take in small-pox, doubtless. 524. Have you any reason to think that small-pox is less isolated than scarlet fever is ?—I have not got the figures, and I cannot answer Avithout the figures. I have no reason to think one way or the other. 525. With your experience as to the mortality from small-pox since 1838, what would be your opinion as to this quotation which I take from the evidence given by Dr. Edward Jenner before a Committee of the House of Commons. He says, It now becomes too manifest to admit of controversy, that the annihilation of the small-pox, the most dreadful scourge of the human species, must be the final result of this practice, speaking of vaccination ?—If your question is whether small-pox is anniliilated, I reply that clearly Mr. small-pox is not annihilated. William Oglt, 526. My question is, rather, whether you think it M.D. possible to annihilate small-pox by vaccination ?—Anni- ~— hilation is a strong term. I think you have already '0 July 1889. diminished it enormously, and I think that if vaccina- tion was carried out more thoroughly and universally than it is, and accompanied by re-vaccination, you would diminish it still further; but as for annihilation, I do not know about that. 527. I think you said in answer to Question 360 that from 1881 to 1887 there were no fewer than 2,032 cases of fatal small-pox certified to have been vaccinated by registered medical practitioners ? — I gave you the figures. I have not looked to see whether those figures are accurately printed, but I have no reason to suppose that they are not. 528. If that were the case, the question of annihila- tion would be exceedingly remote, would it not ?— I do not see why. 529. If 2,032 persons not only had small-pox, but died of small-pox, and were certified to have been vacci- nated by registered medical practitioners, would that lend plausibility to the hope of annihilating small-pox by vaccination ?—There is no evidence whether these 2,032 persons had been re-vaccinated. It is generally admitted that the protective effect of vaccination becomes weakened in time ; and the fact that 2,032 persons who have been vaccinated, perhaps imperfectly, should die of small-pox, does not at all show that perfect vaccina- tion accompanied by re-vaccination might not have saved all those 2,032 lives. I do not say that it would. 530. The present law says nothing about re-vaccina- tion. May I take it that with our present facilities for vaccination and our present compulsory legislation, you can see no hope of annihilating small-pox ?—Are you correct in saying that the present Act does not recognise re-vaccination r I think it makes it gratuitous. 531. I should correct myself by saying that it does not compel re-vaccination ?—It does not compel it. I might, perhaps, be allowed to say that, looking at a single year, the year 1867, the vaccinated who died of small-pox were all over 10 years of age, with one single exception among males, and two exceptions among females. 532. How many deaths were there from chicken-pox ? —In that year the whole number was 85. 533. {8ir James Paget.) At what ages ?—They were all under five. 534. {Mr. Bradlaugh.) Eeferring to your answer to Question 371, to which allusion has just been made, that the Act of 1867, in your opinion, was inoperative ; I do not know whether you have read the evidence of Mr., now Sir, John Simon before the Committee of 1871 ?—I have not read it recently. 535. Are you aware that Mr. Simon then thought that the working of the law of 1867 had fully doubled infantile vaccination ? — Very possibly he may have said so. 536. If your attention had been drawn to that, would you have put it quite as positively that the Act had been inoperative?—I have already said that I should have said comparatively inoperative. 537. In your answer, you go on to say that the Act of 1867 apparently did give permission to boards of guardians to appoint vaccination ofiicers, but apparently they did not comply with it in the greater number of cases. I do not know whether you have had your attention drawn to the evidence of Dr. Seaton given before the same Committee. In answer to Question 5495, Dr. Seaton says, '' The majority of unions in- spected last year certainly had [appointed an officer to find out that the Act was complied with], and so have those which have been inspected this year, up to the present time. If your attention had been drawn to that, do you think that you would have said that the greater number of the guardians did not comply ?—I think I said in a great number of cases, not in the greater number of cases, as printed here ; for as I had not got the actual figures before me, I do not think it is likely that I should have said the greater number of cases, which might have implied that I knew the exact figures. I was informed at the time when thaii table was made that such was the case, but I had no official means of l^nowing whether it was or not. 538. Then you had not regard to the report of the Committee to which your attention has just b^en drawn$