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
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Licence: Public Domain Mark

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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    Sir John practice had prevailed in the East from befoi-e Simoii K.C.B. ^^^^ ^^^^ ^ prevailed from time immemorial. ^ 18. And inoculation was considerably prevalent • 2G June 1S89. amongst the wealthier classes of society during the latter half of the last century, was it not ?—It was. 19. The introduction of vaccination dates practically from the commencement of the present century, does it not ?—Yes; Jenner's first publication was in 1798. 20. Vaccination was practised, I belieee, to some extent before there was any legislation on the subject ? —Yes, for some years there was no legislation, but the Treasury made a yearly grant in assistance of vaccina- tion. 21. Can you teU us when that grant commenced ?— The information wHl be found in a chapter which is not before you,—the 5th chapter of my Eeport of 1857. There was an annual grant to the National Vaccine Establishment,—at first, I think, of something like 6,000Z., but eventually of 2,000L, chiefly for the main- tenance of the supply of lymph. Vaccination under that grant was practised only or almost only in London, but the lymph supply was for the whole country. 22. Can you tell the Commission the date when that commenced?—From early in the century, and it con- tinued down to the year 1840. It was a period of what may be called charity vaccination ; there were plenty of charitable vaccinations in London and throughout the country, and, as in aid of them, there was the parliamentai-y grant. 23. Can you tell us whether at that time the practice of vaccination generally prevailed amongst those who were not in need of charitable assistance ?—It is im- possible for me to speak accurately of the quantity ; but no doubt the practice was spreading very considerably among the educated classes in England. 24. And in addition to that, vaccination was assisted in the case of the poorer classes by charity ?— Yes, but not yet by rates. On the contrary, it had been legally held that an overseer was not bound to take measures to procure the children of his parish to be vaccinated during the prevalence of small-pox. Then in 1840, with amendment in 1841, came the law which instituted public vaccination, vaccination out of the rates; the amendment in 1841 being, that vaccination should not be counted as parochial relief in the disqualifying sense. 25. But although at that time the rates provided means of vaccination, there was no obligation on any- one to avail himself of it ?—None. 26. Can you tell me whether the opportunity of vac- cination was largely taken advantage of ?—I have not at hand the means of quoting figures, but it was certainly largely taken advantage of. 27. But I suppose there would be still a certain number of people who would not have their children vaccinated?—Quite so. 28. What was the next step ?—The next step was that in 1853 an Act was passed making vaccination compul- sory ; promoted by Lord Lyttelton, in the House of Lords, at the instigation of the Epidemiological Society. 29. That remained the law until the year 1867, did it not?—It did. 30. What, putting it shortly, was the change made in 1867 ?—There were amendments of detail; there was no change of principle. 31. There was no really important change ?—No really important change. A really important change was made in the year 1871. 32. What was the change then made ?—An arrange- ment was made by which it became almost inevitable that defaulters under the law should be followed up closely and be caught. 33. So that it was designed at all events to secure a much more complete system of vaccination ?—Yes, by compulsoiy means. 34. And have you reason to believe that it accom- plished that object ?—I think there is no doubt that it generally accomplished that object. 35. That remains the law at the present time ?—Yes. 36. So that for statistical purposes, one may look at the periods prior to 1840 ; then from 1840 to 1853; then from 1853 to 1871; and then from 1871 to the present time ?—Yes; those would be periods of very different characters. 37. There is considerable difiiciilty, is there not, lu the comparison of statistics with regard to this country, owing to there being, prior to a comparatively recent period, no proper statistics of death ?—Quite so. 38. As regards London there were the bills of mor- tality, which purported to record all the buiials in the Church of England bmial grounds, I believe ?—Yes. 39. Were there no similar statistics in the provinces ? —There were the parish clerks' registers, of a very imperfect description, I believe. 40. Those would be only in each i^arish; there was no general record kept ?—No general record. 41. So that the only general record of the death-rate from diseases that we had prior to the time of the general registration of deaths were the bills of mortality for London ?—-Yes. 42. These bills of mortality woiild, however, err, would they not, on the side of showing fewer deaths than the number that really took place —That is believed to have been the case. 43. It almost must have been the case, must it not, because of course they would not record more people as buried than were buried ; and, on the other hand, if only burials in Church of England buiial places were recorded, there must have been some burials not re- corded ; and therefore the number recorded must have been less than the number of deaths ?—Yes. 44. At all events, it could not err in the opposite direction ?—No. 45. There is another question with regard to the comparison of statistics that I want to put to you. Has the classification of the causes of death differed from time to time ?—Enormously ; so much so that one might as well try to talk modern zoology in the language of Aristotle as to talk about modem facts of disease in the language of the years of the bills of mortality. It is a different language altogether. 46. Even in recent years the classifications have not always been precisely the same, have they ?—There have been slight differences even in comparatively late years ; one sees new names growing up in pathology, just as one would see the same sort of thing in botany or chemistry. The old multitudes of unnamed deaths get specific names. 47. That is to say, what was under some more general heading is distributed under more specific headings ?— Some more general heading, and also occasionally special former headings, such as we ai'e not able at pre- sent accurately to translate. For instance, in the bills of mortality, one sees such caiisesof death as chrisomes, mold-shot head, liver-grown, and other names that it is now very difiicult to interpret. Then one sees grown up now Addison's disease, Blight's disease, Hodgkin's disease, and so forth ; diseases bearing the names of the pathologists who first succeeded in identifying them. 48. I think I observed in the statement which you have handed in, that a very large number of the deaths in the bills of mortality were classed as deaths from old age ?—Yes. 49. And, comparing it with more recent statements, there would seem to be fewer deaths from old age now than there were then?—The diseases would now be called by theii' particular names. 50. You have formed an opinion, have you not, with reference to the effect of vaccination in preventing the prevalence of small-pox to the extent to which it for- merly prevailed ?—I have formed a very decided opinion upon that subject; but I am bound to say that it is an opinion that goes on correcting itself in detail from day to day. The best bit of evidence which I have seen since my attention was first directed to the subject, is one which will, no doubt, be before the Commission— the evidence as to the Sheffield epidemic of a year or two ago, evidence from the Medical Depai-tment of the Local Government Board. When I compiled my blue book of 32 years ago, we were only two-thirds of the distance from the discovery of vaccination that we are at the present time. I used what material there was then, but the material has largely increased. 51. Then had you formed the opinion that vaccination had largely diminished the prevalence of small-pox ?— There could be no doubt of that; that was evident. No one capable of argument, I think, looking at the matter impartially, could have doubted that at the time.