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

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.

53/850 (page 43)

$time you must bear in mind he says, Thus somewhat more than counteracting the mischief it did by spreading the disease among those to whom it was not applied. 7884. That although there was more small-pox, yet it was less fatal, the total result being a decrease in mor- tality ? {Sir James Paget.) An increase in the number of cases due to the spreading of the small-pox by the persons affected, but a diminution of the mortality by reason of the number whose lives were saved by it ? (Witness.) My reading of Dr. Guy is this: You have very largely mitigated the disease in those upon whom you have inoculated small-pox; that is true. On the other hand, you have sent those people upon whom you have inoculated small-pox into the midst of a population less able to bear it, and they have had the disease more severely than those you have protected. 7885. {Chairman.) There being two opposing causes, one in the direction of diminished mortality and the other in the direction of increased mortality, the ques- tion is, which overcame the other ?—I cannot go beyond what he said. 7886. {Professor Michael Foster.) What he says is : It did nevertheless effect some saving of life ?— Yes, only in the case of those upon whom it was practised. 7887. {Dr. Collins.) You would agree with what Sir John Simon said in answer to Question 211, when he was asked, Do you consider that inoculation was in any way responsible for the heavy mortality at the end of the 18th century ? To which he said, Un- doubtedly ?—Yes. 7888. {Mr. Meadows White.) At this time, between the dates of 1620 and 1665, have you any diagram or statistics showing the prevalence of any other disease which might have been confounded with small-pox ?— There is one I would be glad to mention. If you would turn to the Appendix to the First Beport of the Royal Commission, page 88, there are some figures which are taken from Dr. Farr upon which I have made this diagram. It is a table of the aimual death-rates in London per 100,000 of all living. Now, what I have done is to take as fevers, scarlet fever, fever, spotted fever, and plague. I have taken the figures which are on that table, and I have put them here in this diagram. {The diagram was handed in. See Appendix III., Dia- gram C : facing page 200.) Here you see the amount of fever that was in this period, 1629 to 1635. 7889. {Chairman.) You include in fever, for the purpose of your diagram, plague ?—Yes, I do. 7890. {Mr. Meadows White.) My question rather was this : we have been told early in the evidence that measles were confused with small-pox at former times, and I want to know if you have any diagram showing the extent of measles at that time showing the rise and fall of the two comparatively 'i—No, I have not. It is only my opinion putting in the plague. I have con- sidered the plague a sort of typhus. Fever, and not only fever, but apparently the whole of the diseases of the country, change in character in course of time; and what is taken as the prevailing disease of one time will not be the prevailing disease of another. I have taken plague for this purpose, together with the fevers. With all my faults and imperfections that is the way I did it, and I did it for the purpose of comparison. 7891. {Professor Michael Foster.) Have you included the cholera of late years?—No ; this Diagram C. in- cludes no cholera. 7892. Ought you not to have included cholera P—All I am doing is to see if there are any fevers which have shown any decline. Cholera was in the large chart, in all other diseases. 7893. (Chavrmdn.) But you included plague with the great plague year, which mounts your column up to a tremendous height; but which, having made great ravages, ceases altogether, you say, in 1680, therefore, that particular cause is gone altogether. You are not comparing diseases that were prevalent during the periods compared ?—But we have got rid of a lot of diseases, not only of the plague. 7894. We have not got rid of anything comparable to the plague, have we ?—The sweating sickness, for example. 7895. Have we any disease that you know of which carried off in London 35,000 of the population in a single year ?—Yes ; the black death and the sweating sickness. o 63670. 7896. But in what year ?—In previous years. I am comparing these things to show what has been the ^ w'heeh great reduction of fevers. Even if you took out plague ' altogether you would have an enormous redaction in jy ^.^^ ^g, fevers, a reduction which is almost without parallel. Here is a proof of the improved condition which caused the mortality table to fall, 7897. {Sir William Savory.) Is there no other explana- tion of that ? We have had it over and over again put before us here that many cases were formerly included under the head of fevers which are separated now from '' fever ; as diagnosis has improved disease after disease has been removed from the category of fever. What do you say to that ?—The only effect of that would be to say you cannot produce any diagram at all. I have simply taken these from materials which have been submitted to you, and which seem to me to show that, at any rate, in fevers the work of Dr. Southwood Smith, and such philanthropists as he, has produced these results. 7898. It is not a question of philanthropy; it is a question of scientific knowledge ? — Dr. Southwood Smith has done, I take it, more for the reduction of fever than anyone in the last 100 years. 7899. {Chairman.) You would admit that unless the classification in the two compared periods is really com- parable, you do not derive any advantage from the com- parison. It all depends upon whether the same thing was meant by fevers in the two periods ?—Yes ; but I think that is near enough to go by. 7900. (Sir James Paget.) Could you subtract those diseases which would not now come under the head of fevers, such as inflammation of the lungs, pleurisy, inflammation of the brain, pytemia, and the rest which were all included as fevers, could you take those away from your list ?—I think in the term fever you would get a classification as simple as any, and although there would be many complications, yet through all the years the bulk of the fever cases would maintain that. 7901. Have you any medical knowledge with respect to that question ?—No, I have no medical knowledge whatever; I do not make the least profession of any. 7902. {Dr. Collins.) With regard to this particular table from which you constructed that diagram, are you aware that Sir John Simon says, on page 378 of the Eeport of the Committee of 1871 : '' Dr. Greenhow, throwing into one group all those deaths of the present day which might have been included under the old application of the word 'fever' (counting scarlet fever, and inflammation of the brain, and inflammation of the lungs in this category), still finds that even with this '' large addition the so-called ' fever' of the present day occasions only a death-rate of 385 per 100,000, whereas a century ago its death-rate was close on 539 ?—It was in consequence of the use of those words in Mr. Simon's paper that I produced this dia- gram. As I say, if you take out the plague you will have the same remarkable fall. I did not do it on my own authority; I did it, as I have stated, upon the authority of Mr. Simon. 7903. (Sir William Savory.) But, apart from autho- rity, if it be the fact that diseases which were at one time classed as fevers are now separated from it that must inevitably affect your table ?—Yes; but at the same time I take Mr. Simon's use of these words to mean that I have nothing here but what would be likely to be included in this term. 7904. {Dr. Collins.) Do I understand that under the term fever there are included in the table from which your diagram is taken such diseases as inflam- mation of the brain and inflammation of the lungs? — Yes, I understood so ; that was how I read it. 7905. (Sir William Savory.) You were going to ex- plain a point with respect to' the population ?—Then I ask what was the population of London, and what was its condition during this period. In Mr. Simon's papers of 1857, Appendix, page 26 and onwards, on the death-rates in London by Dr. Greenhow it is stated at page 29 that the population of London was, from 1681 to 1690, 530,000 ; and from 1746 to 1755, 653,000. The death-rates from all causes, and from small-pox, are given as follows : from 1681 to 1690 as 42-1 per 1,000, small-pox representing 3139; from 1746 to 1755 the deaths from all causes are given as 35'5 per 1,000, and from small-pox as 3'004, That shows a reduced death- rate from all causes, but not so largely reduced as the small-pox death-rate. But this death-rate is founded on a pure conjecture. No one knows the population of G$