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.

    786/798 (page 214)
    259. At Warrington, where in 1892-3, according to Dr. Savill, tlie Vaccination Acts had been so thorouglily carried out that more than 99 per cent, of the people, according to his census, are vaccinated, the want of proper isolation accommodation was held, accountable for the extent of the epidemic. Dr. Savill says :— It will be gathered from the foregoing narrative that insufficient or imperfect isolation was an extremely impor- tant factor in the causation of the Warrington small-pox epidemic 1892-3. This was owing partly, in some instances at the commencement, to a non-recognition of the cases ; but it was due chiefly to an absence of hospital accommodation sufficient for the reception and isolation of the patients as soon as they were attacked and identified. The sanitary authority had neglected to act on the recommendations of their 7Jiedical officer of health in this matter of hospital provision. The purchase of additional land for that purpose was contemplated in the summer of 1890, but it was not carried out until October 1892. It is rendered evident from a close examination of the facts of the epidemic that if the town of Warrington had possessed adequate hospital accommodation for infectious disease the epidemic would probably never have reached the dimensions it did, and the disease would in all probability have been limited to a few cases in certain quarters of the town. Warrington obtained notification by a Private Act in 1879, and in the epidemic of 1892-3 only 16 cases out of the 667 escaped notification. At the commencement of the epidemic the totah provision for the hospital isolation of infectious diseases was 30 beds, or less than half the very lowest estimate of that required. As a consequence of this only 13 cases could be received into the Borough Fever Hospital by dangerously overcrowding every available space. The hospital is situated in a rather thickly-populated part of the town. It appears that an outbreak of small-pox in May 1892 (consisting of three imported cases and one secondary case) was effectually dealt with by isolation, disinfection, and quarantine; but on the 18th of the same month the medical officer of health reported to the sanitary authority that up to the present time we have been able to cope with introduced cases notified from the borough, but, as I pointed out in February 1889, there is very great danger in treating small-pox cases in close proximity with a populous neighbourhood as Aikin Street is, and two full wards of scarlet fever in *' our own grounds. It was. not, however, until the epidemic had established itself in the town that additional accommodation was provided in September 1892, at some disused Iron Works in Dallam Lane. These were situated near the northern fringe of the populated part of the town, but there appears to have been ample opportunity for communication with the outside world, at any rate, during the height of the epidemic. Owing to deficient hospital accommodation, 91 cases were left at home, either altogether, or for periods varying from two to 22 days after the appearance of the rash. The limit of hospital accommodation was twice reached, viz., on August 23rd, when the old hospital became full, and on November 12, when the new hospital was also full. Dr. Savill traces 308 and 102 cases respectively to lack of hospital accommodation at these periods of arrest of rem_oval. The spread of the disease within the hospital and workhouse are also attributed to insufficient isolation and overcrowding. In the preliminary outbreak in May 1892 the whole family was quarantined, and this may be the reason why this outbreak spread no further. With this exception, no measures for the actual removal and isolation of the healthy members of an infected household were adopted in the case of the Warrington outbreak, and though persons were enjoined to avoid contact with the infected, there is reason for thinking little care was exercised in this respect, and no efforts at regular daily inspection and supervision, such as those adopted at Leicester, appear to have been made. In view of the limited provision for isolation, we agree with Dr. Savill, that it is not to be wondered at that on this account the small-pox epidemic of 1892-93 reached the alarming proportions which it did. 260. The facts in regard to the methods adopted at Leicester and Sheffield will be found in sections 480-487 of the Eeport. 261. In regard to Gloucester, although we have not yet received the complete report of Dr. Coupland, we learn from him that the following circumstances contributed to the extension of the disease :— 1. A main factor was the introduction of the disease into some of the public elementary schools.