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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$The northern district, again, has been striking in that respect, containing as it does the Northumberland and Durham coalfields. I will not at the moment say that this is a sufficient explanation of it, but it is a pretty well-known fact that the custom of vaccinating in one place, for example, instead of four, has been very habitual in some parts of London, and it has also been to a large extent practised in colliery districts. 698. {Professor M. Foster.) If we had the diiferences in per-centages it would be clearer. In the eastern district, for instance, there is a very great diminution under five years of age, from 47 to 27, coincident with an increase from five to six in ages above five ?—Yes. 699. And in the north-western district it is the same to a less extent. That would rather militate against the general deduction that you were drawing, would it not P Possibly, so far as mere quality of vaccination is concerned. 700. [Mr. Bradlauglh.) There are several mining dis- tricts to which it does not apply ?—Yes. 701. {Ghairman.) What struck me was that there are only two districts where you may say that the diminu- tion under five years of age is very small indeed—in London 130 to 116, and in York 116 to 107; and in each of those there is an increase of small-pox over five years of age ?—Yes. 702. (^Sir Guyer Hunter.) You stated just now, did you not, with reference to the small diminution in Lon- don and York, that in London and the mining districts the quality of the lymph was probably at the bottom of the evil ?—Not the quality of the lymph, the method of vaccination. I was referring to the habit of vaccinating in one place instead of four, which has been very habitual in some parts of the kingdom. 703. But why should that apply specially to London ? I think you know what the sixpenny doctor in Lon- don is and what he does, and he prevails in London more than anywhere else. 704. That applies to York also?—It applies to the York Division and to the colliery districts especially ; but I am not prepared to give you that as the whole of the explanation, and perhaps I may supplement my answer later on. 705. {Chairman.) The striking feature of this appears to be the very small diminution in London and the York Division in the infantile death rate as compared with all the other districts. They vary considerably, but none of them show a diminution anything like so small as in the London and Yorkshire districts ?—It always is so in London. We never get rid of small-pox in London to the extent to which it is got rid of throughout the country as a whole. How far it is due to the method of vaccination in the York Division, and how far to differing amount of small-pox, I would not say at the moment; but I will endeavour to find out if I can off'er you any fuller explanation of it. It would involve a very detailed examination of statistics of a number of places in order to enable me to do so. So far as this table is concerned it ought to be accurate in every re- spect, but I may perhaps say that some of the tables do not profess to be absolutely accurate because they are in part compiled from statistics which, in some respects, the Registrar-General does not profess to give in an absolutely trustworthy shape. 706. Will you proceed with your statement ?—I was endeavouring to show that the failure to reduce the death-rate over five years of age, whilst the death- rate under five years of age was being so enormously reduced, was apparently, so far as we can judge, due to an alteration in the behaviour of small-pox in so far as it has aifected this country. Dr. Ogle has pointed out to the Commission from the 43rd Annual Report of the Registrar-General how this has operated, and he has given statistics showing this ; and I may say that the same point was insisted on by Dr. Buchanan in his Annual Report for 1884. For example, at page xiv. of the reprint of that Report Dr. Buchanan writes : The resistance to adult small-pox, formerly afforded by an infantile attack of small-pox, was almost complete and lifelong. It has been exchanged nowadays by a larger '' number of people for the resistance furnished by the average English ■yaccMia^iore and then he refers to the Registrar-General's statistics as bearing this out. That Report shows, along with the fact I have men- tioned, the vast superiority, as a protection against small-pox, of that sort of vaccination which is required of all vaccinators whoSe work is subjected to State supervision as compared with that which is not so Mr. Richard supervised. For example, Dr. Buchanan, dealing with ThorneThome, this point at page 6 of the reprint, deduces the fact M.B. which he says is creditable to the public vaccination of London, that it protects against small-pox much ^^^ 1889. more than private vaccination; and on the next page he says, in referring to children who died from small- pox under 10 years of age : '' There was one child, and only one, of whom it could be said that vaccination had apparently been performed in the manner con- templated by the Board's instructions, and yet had died of small-pox contracted whilst it was in its usual health ; and, again, as regards this age-period the very great bulk of the vaccinations performed by pubhc vaccinators have been protective against death by small-pox during the recent epidemic. I would hand in here a table which bears upon this point, and which is an analysis of a report which Dr. Gayton of the Metropolitan Asylums Boai-d made of 10,403 cases of small-pox. (The table was handed in. See Ajipendix III., Table B : page 117.) He shows the fatality per cent, of the attacks, and there he divides (a matter which I have not before referred to) the scars according as they were good or imperfect. If you will look to the first part of the table you will see that there is, with four good scars an absolute immunity from death up to the age of 15; and with good scars, whether one, two, or three, there is an absolute immunity from death from small- pox up to the age of five. In other words, the very \ period of life at which small-pox in its natui-al state is ! most fatal, is the period at which when the scars were \ good no death whatever took place. The second part of ^ the table shows the same thing when all the good vacci- nations and imperfect vaccinations respectively are lumped together. It shows, for example, that from 10 to 15 and from 15 to 20 years of age the good vaccina- tion afforded just three times the amount of protection against small-pox death that the imperfect vaccina- tion afforded. In fact the whole table shows the special value at each of the age periods mentioned of what Dr. Gayton terms good as opposed to imper- fect vaccination. Then with regard to the increase of small-pox at ages over five years, both Dr. Ogle's and Dr. Buchanan's conclusions are to the same effect, namely, that it is due to the fact that the almost complete resistance to adult small-pox which was formerly afforded by an infantile attack of small-pox has, as one vaccinated generation has followed another, been exchanged for the protection which is aff'orded by the average English vaccination. 707. Do you mean to point out that the protection of infantile vaccination is less than the protection of in- fantile small-pox ?—That is so ; and the tables and all the material which we have now collected go also to show that for many persons the protection against attack afforded by vaccination is of chief avail for the first few years after that protection has been obtained, and that, as a complete protection against death from small-pox infantile vaccination cannot be relied on as lasting throughout adiilt life. 708. {Sir James Paget.) Are there any returns any- where of the number of cases of second attacks of small-pox in former days ?—I do not see how they could have been collected. A number of. authors give occasional records; Aitkin, for example, in his Theory and Practice of Medicine mentions instances of small- pox occurring several times in the same person, but does not always give the number of attacks. But, as a matter of fact, one attack of small-pox has been generally held to be a practical protection against a renewal of the disease during lifetime. 709. In the column in your table headed '' Four or more Scars, Good, it is only the period between the ages of 15 and 30 in which there are deaths with good scars ?—Yes, I imagine that the paucity of the numbers at the ages beyond, namely, 30 to 40 and beyond 40, had to do with it ; few cases ar those ages coming under consideration. Of course it is a limited experience by one single officer. 710. {Professor M: Foster.) I was going to ask you how these cases were recorded and what was the natm-e of them ?—They were the cases which Dr. Gayton had under his care at the hospitals with which he was con- nected. 711. Is there any statement anywhere of the number of cases at the respective ages ?—Yes, in his paper on the Value of Vaccination. With regard to the absence of death in persons over 30 years of age with four or more good scars, I may add that there were very few people in the hospitals at 30 and 40 years of age who$