Volume 2

Reports of the Royal Commission appointed to inquire into the subject of Vaccination; with minutes of evidence and appendices / Vaccination Commission.

  • Great Britain. Royal Commission on Vaccination.
Date:
1889-1897
Catalogue details

Licence: Public Domain Mark

Credit: Reports of the Royal Commission appointed to inquire into the subject of Vaccination; with minutes of evidence and appendices / Vaccination Commission. 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.

    586/798 (page 14)
    under two years of age were excluded certainly cannot be regarded as establishing it. It is to be observed that although the average fatality in what are known as Jurin's cases was only 16*5 per cent., the fatality in the various epidemics from which those statistics were compiled varied greatly, ranging from 10 to 36 per cent. There are instances where the fatality has been even less than 10 per cent. As has been already remarked, the fatality of small-pox differed very greatly in different epidemics. Ber- nouilli, in taking the average fatality quoted above, remarks on its great variability, it may be as high as 1 in 3 (and indeed still higher results have been recorded), or as low as 1 in 40. The records of the London Small-Pox Hospital from 1746 to 1763 showed a fatality of 25*3 per cent., and it has been stated that during the last 25 years of the last century 32 per cent, of those admitted succurabed to the disease. In the Bill of Mortality of the town of Warrington for the year 1773, by the Rev. J. Aikin, communicated by Dr. Percival to the Eoyal Society of London, it is stated that in one neighbourhood, out of 29 who had the disease 12 (that is to say, 4L3 per ' cent.) died. He states, further, that in other neighbourhoods the fatality was still greater, and that he had reason to believe that it was not less on the whole. There can be no doubt thiiit the fatality of small-pox differed very greatly in different epidemics. So great are the variations that only very large numbers would justify an average being accepted as showing what may be called the normal or natural fatality. It is much more important to bear in mind that the fatality differed widely on different occasions. 54. One character of the small-pox in the eighteenth century (and there is nothing to prove the state of things before the eighteenth century to have been different) is brought out in all the records in which the ages are given, namely, the large proportion of the deaths contributed by the very young. Thus in Chester, in the epidemic of 1774, all the 202 deaths were of those under 10 years, and a quarter of them under one year. In Warrington in 1773, all the deaths were of those under nine years. In Q. 24,823 Kilmarnock, of the 622 deaths occurring between 1728 and 1763, the ages of nine not 24,979. being given, only seven were of those above 10 years. The burial registers for the graveyard of St. Cuthbert's, Oanongate, and Buccleuch Street, Edinburgh, show that 6, App, 642. during the years 1764-83, the proportion of deaths from small-pox of those below the ' age of ten years, to every thousand deaths from that disease at all ages, was 993. Indeed in all records of epidemics in which the ages are given, the mortality was mainly amongst infants. It is also seen in the larger records, covering periods including both epidemic years and years which were not epidemic, as in those of Geneva (1580- l, App. 76. 1760), which show that the feature was apparent earlier than the eighteenth century, iu those of Sweden (1774-1800) and in those of other places. Incidental references in various writings show that the fact was recognised at the time; thus Haygarth observes that in Chester in the years 1772-1777, of those under 10 years, half as many die of the small-pox as of all other diseases ; and this feature of small-pox is assumed in the calculations of Bernoulli referred to above. 55. The first quarter of the 19th century was characterised in this and other countries by a striking decrease of small-pox. 56. In the London Bills of Mortality the returns of small-pox for the year 18O0 are 2,409. This was the last return so hisrh as 2,000. Prom thence onward the number of deaths from small-pox fell, especially after 1810, reaching in 1818 so low a figure as 421; the fall being irregular and marked by epidemics as in 1812, 1817, and 1825. This decline is all the more striking since during this period the population of London within the limits of the Bills, increased from 746,233 in 1801 to 1,180,292 in 1831. As has been already urged the Bills were imperfect, and there is ground for believing that during this quarter of the century the imperfections were greater than in former times. This is confirmed by the fact that the returns of the total deaths, in spite of the increased population, were on the whole not greater, in many years even less, than in the preceding century. Making every allowance for the effects of improved sanitary conditions, this feature of the returns may be taken as evidence of their imperfection. Still, in spite of their imperfect character, the Bills show that during this quarter of the century, a striking change took place in small-pox in London. 57. Adequate records of the prevalence of and mortality from small-pox in parts of England other than London, during the first 25 years of the nineteenth