Third (-Fourth-Fifth) 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:
1890-1893
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Licence: Public Domain Mark

Credit: Third (-Fourth-Fifth) 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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    '7398. Is there aay reason to believe there were ?— That I am unable to say. The change has taken place undoubtedly, but how far it took place and exactly when it would require a person well acquainted with each country to determine. 7399. Has there been any change in all the countries of. Europe corresponding to that in London coincident with the diminution of small-pox ?—That I cannot say at all. 7400. It has been said, I suppose with some truth, that in the East Indies and the West Indian islands and elsewhere, the introduction of vaccination has been followed by a great diminution of small-pox ; may that be generally accepted as true ?—I think I have seen statements rather to the reverse effect. 7401. Where are they to be found?—I cannot say at the moment, but I think I have read reports from officials in India to the effect that small-pox is spread- ing very much since the introduction of vaccination; but it is mere memory ; I can give no authorities at all. 7402. There are no official records of that, are there? —Not that I can lay my hand upon. 7403. Would it be true in nearly every case that there has been a diminution of small-pox following upon vac- cination ?—I admit the diminution of small-pox, but the whole question is as to the cause of the diminution. 7404. Where vaccination has been introduced later than the beginning of this century the same result has followed in small-pox, has it not ?—That is a general question about which I know nothing ; I. cannot answer that. 7405. Would you be disposed to assign the contrast between the prevalence of small-pox in the beginning of this century and the end of the last to sanitary con- ditions ?—To general changes, and to the cessation of inoculation. 7406. The exercise of inoculation was not supposed to increase materially the mortality from small-pox in the last century, was it ?—It has always been quoted as doing so. 7407. You yourself stated in the course of your evidence that the practice of inoculation was diminish- ing in the last 20 years of the last century ?—Yes, and the small-pox mortality was diminishing in the last 20 years of the last century. 7408. Was not inoculation diminishing much more in the first 20 years of this century ?—Yes. 7409. It was diminishing, was it not, at a far greater rate than small-pox was diminishing ?—Yes. perhaps it was. I believe that the figures show that the 17th century mortality from small-pox was not so bad as that of the 18th century, generally speaking. 7410. {Chairman.) Is it not the fact that the last 10 years of the last century do nob seem to show very much change as compared with the 10 preceding years ? —No, I think not. 7411. I am referring to the diagram; the variation of the height of the columns differs somewhat, but if you compare 1780-90 with 1790-1800, there does not seem to be much to choose between them?—No; but Mr. Parr stated from his examination of the statistics that there was a decided diminution in the last 20 years of the century as compared with the preceding 20 years. 7412. But that does not appear upon the diagram ?— It does not. 7413. {Sir James Paget.) Has there been a correspond- ing diminution in the prevalence of other epidemics than small-pox under improved sanitation ; scarlet fever, for example ?—I think there has been a corresponding diminution of typhus fever, which I show upon this diagram. 7414. But were you aware of the number of diseases which were included under the name of fever at that time which are now separated from it ?—Yes, but I am speaking of the period since official registration ; there is a decided diminution of typhus, quite as much as of small-pox. 7415. But that did not begin, according to the tables, till 30 or 40 years later than the diminution of small- pox; take the tables of the present registration, that was much later than the beginning of the century ?— I have not examined the tables for typhus fiom the beginning of the century. 7416. The J amber of cases recorded as fever in Mr., this century has been diuiiuisbcd l y the separation of A. R. Wallae, cases which were not subsequently included under LL.D.,D.C.L. fever ?—That is so. 5 Mar. 1890. 7417. Taking such cases as scarlet (ever or whooping cough, which are often cited, they have not diminished in anything like the same proportion as small-pox did ; are we to suppose that there were special sanitary con- ditions which affect the occan-ence of small-pox ?— Therft are a great many opinions upon that point; there is the evidence and the opinion, which no doubt yOu will have before you, with reference to the fact that the diminution of small-pox does not imply a diminution of the total mortality, that it is made up by other diseases ; but that is a question of piirely medical statistics, to which I do not wish to pay any special attention. 7418. Now, as a method of testing the result, would it not be fair to take the case of persons living under exactly the same conditions, the same class of popula- tion with the same habits of life, and then to see whether the vaccinated have less small-pox than the unvaccinated ?—Yes, certainly, if you could get population living under the same conditions. 7419. Take the whole population of Sheffield and the returns we have from Dr. Barry; they are, on the whole, very similar ; I think I may say that in every instance Dr. Bairy found the vaccinated less sus- ceptible to small-pox than the unvaccinated ?—Yes, but that, of course involves a quesdon I do not wish to go into, but which, no doubt, you will have before you, as to the accuracy of the distinction between the vaccinated and the unvaccinated. 7420. But he has distinguished them by taking the vaccinated, on the one side, and the unvaccinated and doubtful on the other side, and the vaccinated still show a majority of cases of immunity ?—Perhaps so'; that is, as 1 say, a point upon which I do not wish to give evidence. 7421. Is it not fairer to take that case and other cases like it as a simpler example of the influence ol vaccination than to take the whole of Prance, with populations so unlike and with returns in which there are evident uncertainties ?—I do not see myself that the case of the vaccinated and the unvaccinated in a town is such a simple case, because the unvaccinated would be necessarily, to a very large extent, nf the very lowest class, including the tramps and the criminal classes, and also children who were too delicate to be vaccinated, and children who got small-pox' before they were vaccinated, and involving a number oi conditions which reiider the separation between the vaccinated and the uiivaccinated not a fair separation. 7422. Taking what you say, that the poor are much less vaccinated than the rich, is that really true ?—I think it is if you take the poor down to the very dregs of the population. 7423. I speak rather of the ordinary inhabitants of a place—the children in the schools, or children in the same ranks of life ; is there so important a difference between the conditions of the vaccinated and the un- vaccinated as there is in their susceptibility to small- pox?—I cannot give an opinion upon that; we have, however, other statistics which exactly contradict those of Sheffield; we have uhe celebrated statistics of Dr. Keller in Austria. 7424. May I ask whether you are aware that Dr. Keller's statistics have been found to be partly false ?— I am not aware of that. 7425. {Chairman.) Are you aware they have been gravely called in question?—I am aware that every statistic is called in question by those who do not like the results produced from it. 7426. {Sir James Paget.) Are you aware that the statistics which he quoted have been examined and found not to justify the results he collected from them ? —I have seen that stated, but I have seen it con- tradicted again. 7427. We may take it that Dr. Keller's statistics are not now received as unquestioned ; but taking our own country, are there any statistics upon which the vac- cinated have presented a larger proportion of cases of small-pox than the unvaccinated?—I cannot say; but, as I have said already, I do not think the two cases are comparable; it is impossible here to get two com-