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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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 Simon, X.C.B. 26 June 1889. on we have learnt, as of unquestionable experience, that, even after vaccination aLsolutely good, there will generally be after a certain time a certain re-acquire- ment of susceptibiUty for small-jjox. 69. Do you mean that there is a certain re-acquire- ment of it in every case, or that in the whole number of cases there is some re-acquirement of it ?—In a large proportion of cases there is re-acquirement of suscep- tibiUty ; we have not the exact measure yet. It prac- tically would be impossible to make statistics for the purpose that should distinguish between the better and the worse vaccination ; but taking the vaccinated in lump, I should say, as certainly applicable to the majority of them, that they have some degree of re- susceptibility ; and I believe that the degree in which they have it depends, probably, in part, on personal conditions, but in greater degree on the quality of the original vaccination. Even where there has been good vaccination there undoubtedly is in general a need for re-vaccination at or before the age of puberty. 70. Is it your view that persons who had been originally vaccinated (taking, of course, not an individual case but the average) would be in a better position as regards smallpox than persons who had not been vacci- nated at all.P—I regard the statistical evidence as overwhelming on that point 71. Notwithstanding the fact that it is not absolutely permanent ?—There is not a doubt that even with that drawback a man who has been vaccinated is in a much better position than if he had not been vaccinated. The Commission will find very good evidence on that point, as well as on many others in the admirable report on the SheflEield epidemic. 72. With regard to vaccination being a better protec- tion if it is more complete, which you referred to as also being a comparatively modem discovery, what were you then referring to ?—There is a famous tabulation, by the late Mr. Marson, of deaths in the Small-pox Hospital. So far as he had got his results in the fifties, they were published in my report of 1857; but he afterwards considerably extended them, and they were always to the same general effect, which was this,—that the death-rate of those small-pox patients who were having small-pox after vaccination went in proportion to the insufficiency of the original vaccination. 73. How was that determined ?—Mr. Marson's ex- perience as resident medical officer of the Small-pox Hospital extended I believe to 40 years, and, for more than thirty years, he took exact notes of all the vaccina- tion-marks iie could discover in the thousands of small- pox cases which came under his care in the hospital. 74. It might be convenient if you were to give us the results?—I obsei-ve that I say to the Committee of 1871— Mr. Marson having personally laid before the Committee his complete experience down to the present time, I think it unnecessary to subjoin his particulars. Therefore, I may best refer to his evidence in the 1871 Blue Book. 75. Mr. Marson is dead now ?—Mr. Marson is dead, unfortunately. I refer to his earher experience at page xxviii of my 1857 Eeport, and Mr. Marson put his completed before the Committee of 1871. It is in their report at page 23C. 76. How is the successful vaccination ascertained ; is it by the number of marks left on the arm?—Vac- cination produces a characteristic vesicle, running a characteristic course. 77. But what trace does it leave behind it so that at a later date it can be ascertained whether there has been successful vaccination or not p—It leaves a very definite scar—a peculiar scar. 78. And does the classification of the completeness of vaccination depend upon the number of those scars or upon their character?—It depends upon number of scars, or on size of scarred surface, only so far as the scars are characteristic ; that is to say, scars not charac- teristic on the arm might mean any accident, any burn or any cut with a knife. 79. I do not mean that, but does a scar that un- doubtedly arises from vaccination show a different characteristic if the vaccination has been more success- ful or less successfiil. I want to know what is the test which enabled Mr. Marson or anyone else to classify the vaccinated cases into more successful or less successful ? If the local result of vaccination has been regular for its three weeks duration, at the end of that time there remams a particular soi-t of scar. If there has not been a regular course the scar will not joresent the normal characteristics ; it will present the kind of scar that any chance ulceration might have made. Then, where there are say five marks (that is the number they prefer to have) of a particular sort, the observer infers that at those five spots vaccination has run its course normally. He would class that case as a case of successful vacci- nation, and that case he would offer to be tested by small-pox. 80. That is to say, that a competent person examining the arm afterwards would be able to judge from the character of the marks there whether the vaccination had effected its purpose more or less completely ?— Whether it had run its normal course; on which then his inference would be and will therefore protect '* against small-pox. 81. And I understand you to say, that the result of Mr. Marson's investigations was that the more clear the indication of successful vaccination the smaller the number of cases in which the persons were attacked by small-pox ?—His observations related only to the relative severity of attacks, not to the relative frequency. The latter he had no means of judging; but as to relative severity, the degrees were inverse to the vaccination- marks, and the differences were very great. 82. You have not continued your statistics beyond the year 1857 ?—No. In 1875 I put before the Local Government Board a report which Dr. Seaton had prepared, on the statistics of the great small-pox epidemic of 1870-3 in relation to vaccination and the vaccination laws, and I then submitted some general observations on our measui'es for prevention of small- pox ; but since 1857 I have not reported statistically on the same scale as then with regard to small-pox and vaccination. 83. In what year was the great small pox epidemic? —Prom 1870 to 1873 ; it was an epidemic all over Europe, perhaps partly in connexion with the German war when a great diffusion of small-pox by French troops took place. 84. It was not confined to this country ? —Oh no, it was all over Europe. 85. But England suffered as well ?—England suffered very largely indeed. 86. You have not prepared any statistics yourself comparing the later periods when vaccination had been more completely enforced with the earlier periods when it was only voluntary ?—I have not prepared any myself, but any that I could prepare would be of no value as compared with those which the Registrar-General has at command; and the best answer I could give on the subject would be to quote a table, which I have in my hand, founded upon his material. It makes comparison of three periods differentiated by differences of law as to compulsion : i.e., first, the period of optional vacci- nation, secondly, the period of obligatory hut not strictly enforced vaccination, and thirdly, the stricter period; in other words, the three periods 1847-53, 1854-71, and 1872-80. That table shows for the three periods succesive decHnes of the small-pox death-rate for all ages. The rates for the three periods respec- tively are : 305, 223, and 156. 87. Did the period of 1872-80 include the period of the small-pox epidemic ?—The epidemic lasted for about 24 years. About half of it as to time, and about six- elevenths of it as to deaths, belonged to the period 1854-71 : and the remainder belonged to the period 1872-80. 88. I thought you gave 1872 as the date of the gi-eat epidemic ?—The tail of it was still existing in the spring of 1873; it began in 1870. But the more important column in the table is that which shows what happened as to children under five years of age who of course were the class chiefiy affected by the differences of compulsory law. In the first period their death-rate was 1,617, in the second period it was 817, and in the third period it was 323. 89. (Dr. Collins.) Is that per milKon living?—Per million living. 90. {Mr. Bradlaugh.) That is taken from Table L, on page xxii of the 43rd Annual Report of the Registrar- General, is it not ?—I think it is, but the paper from which I am reading is a paper of Dr. Buchanan's. 91. {Chairman.) I will not trouble you further with those statistics, because we shall get them from the Registrar-General. Is there any other fact that you would wish to bring before the Commission with refe-