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 177. Then I understand that a ijerson once vaccinated Siimm, KJ^.B. is practically in the position of a person who has had the small-pox ?—I believe so. 2G June 1889. -^.^S. Is it or is it not a fact that the majority of re-vaccinations are successful ?—I was not there speaking of an immunity extending through life. I discuss that later on in the paper. I was speaking of the particular moment when the artificial disorder was concluded. 179. Can you tell the Commission how soon after the primary vaccination it is possible to re-vaccinate success- fully ?—I do not know. 180. Is it or is it not a fact that the majority of re-vaccinations are successful in the case of recruits entering the army, for instance ?—I believe it is. 181. Something like 90 per cent, of the cases, I think, are successful ?—Yes, I assume so. 182. If that be so, can you regard a second vaccina- tion as standing in the same relation to the primary vaccination as an attack of small-pox would do to a primary attack of small-pox ?—These are subtle physiolo- gical questions to which there are statistical answers, but I have not the statistics fresh in my mind, and I would rather not answer them speculatively. 183. Do I understand you regard vaccination as equivalent to an attack of small-pox as regards subse- quent susceptibility ?—I think I should venture in that context to say, analogous rather than equivalent. 184. But I think you said on an earlier page of this 1857 paper that a person once vaccinated is protected from small-pox, because he has in fact had it ?—It is quite true that 32 years ago that was my language. 185. Is that one of the points which you desire to modify now ?—It was figurative language. 186. Not pathologically precise?—It was not meant to be pathologically precise. What the person had had was not literally small-pox, bxit (if the explanation I have given be right) was modified small-pox, vaccino- small-pox, variolce vaccince. In 32 years one learns to express oneself more precisely in pathology. 187. Mr. Pioton asked you with regard to the views which Jenner entertained as to cow-pox, and I will ask you whether or no this is a correct passage from his inquiry. He is speaking of horse grease. He says : It is an inflammation and swelling in the heel, from '' which issiies a limpid fluid possessing properties of a ■ very peculiar land, which seems capable of generating '' disease in the human body, after it has undergone the '' modification I shall presently speak of, which bears '' EO strong a resemblance to the small-pox that I think it highly probable it may be the source of that disease is that correct ?•—If you read it as his I take it as his. I have no reason to suppose it otherwise than correct. 188. Do you suppose it to be pathologically correct ? —That is another point. 189. Apparsiatly Jenner held that horse grease was both the source of cow-pox and of small-pox ?—That it was itself equine small-pox, and was the soui'ce, or one of the sources of cow-pox. I suppose we may take it for granted that the horse was capable of a good many maladies about its heels. Jenner took a pretty long- while, and also his successors have been giving a great deal of time to the discrimination of the disease in cows ; and probably in horses the subject was not less difficult. 190. Tou speak of discrimination of the disease in cows. Do I understand that there are a variety of eruptions of the teats of cows?—Undoubtedly. 191. How is it possible to distinguish that which will give true pox from that which will no^ p—How is it pos- sible to distinguish any two diseases ? How is it possible to distinguish epilepsy from measles ? They have different signs. 192. Could you tell us the signs ?—An expert can. I do not profess to be an expert in the diseases of the cov/, but if you would care to follow this point more minutely, there are observers at the present time who can give the distinctions to you, I believe, very exactly. 193. Is it not a fact that lymph has been derived from various original sources at different times for the purpose of vacciaation ?—There is room for misunder- standing in your question. 194. Is it not a fact that lymph has been obtained by inoculating a cow with small-pox for the purposes of vaccination ?—Yes. 195. Is it not a fact that lymph has been used from the cow-pox derived from horse grease iibculated upon a cow; was not that Jenner's source ?—Within my experience, lymph has not been derived from the horse. 196. Have you any reason to doubt that observation of Jenner's ?—I know that he believed the grease of horses to be of the same contagium with cow-pox, and that to some extent in part of his career he inoculated with human lymph which had descended from equine infection ; but I have never attached any particular importance to that portion of his practice, and I have not much recollection of pai-ticulars relating to it. 197. I thought that you commended his work as a masterpiece of medical induction. I take it that you are familiar with its chief points ?—I am not now familiar with the details of his cases. I have not looked at his book for many years. 198. Is it not a fact thai lymph has been di-awn from so-called spontaneous cow-pox's'—Yes. 199. And you have had several instances of such ?— I have had knowledge of several instances. 200. At any rate, there are thi-ee sources from which lymph has been derived at various times?—And there have been derivations of lymph from variolated cows. 201. I mentioned that in the first instance. Are these all precisely the same disease ?—They are believed to be. I do not wish to include the horse's heel, because although I have not the least doubt that the horse's heel has had cow-pox, I do not know the effect of inoculations from the horse sufficiently to speak of them; but I have not the least doubt that cow-pox has been in the horse's heel occasionally ; and assuming the case to have been correctly diagnosed, I can quite conceive that this would give as good vaccination as any other lymph. 202. Axe you aware that Jenner considered so-called spontaneous cow-pox to be spurious and worthless as a protection ?—He probably had not exhausted the subject oi* the eruption on the teats of cows. Quite lately, in a controversy v/^hich has arisen about cows and scarlet fever, it has been made quite evident that cows are subject to very various eruptions upon their udders. I am not at all prepared to say that Jenner had exhausted that subject. I think it very probable that he had not. But when I look at the question of vaccination, I look at it independently of the question of origins; that is to say, remote origins. I look at current vaccination, such vaccination as you will find at any well-conducted vaccination station in England. 203. I believe a calf lymph establishment has been opened by the Government, has it not, in recent years ? —There is a calf lymph estabhshment. 204. Can you tell me the origin of that lymph?—I cannot ; that has been since my time. 205. Now, to go back to the question of small-pox in the centuries preceding vaccination. I believe Sydenham Avas the first to discriminate between small-pox and measles, was he not ?—I am not quite prepared to say that. 206. Was small-pox discriminated definitely from measles before the time of Sydenham ?—In English literature, I believe not; but the London Bills of Mortality reach back to 1629, and the earliest of them (when Sydenham was barely five years old) name small- pox and measles as different diseases. 207. Can you tell the Commission anything of the mortality from small-pox in the 17th Century ?—I give some statistics of it as far as they could be got from the bills of mortality ; and it is as well to note here that the Bills of Mortality, very deceptive for some purposes, are not so deceptive when they positively name small- pox—the disease was tolerably definite. In the statistics which I quote at page Iv. of my report of 1857, I find that small-pox in the years 1629 to 1635 gave 189 deaths per 100,000, and in 1660 to 1679 gave 417 per 100,000. 208 Per 100,000 deaths, is that?—No, per 100,000 of estimated living population. 209. The first period would be before the time of Sydenham, I apprehend ?—Yes. 210. How does that compare with the mortality from small-pox in the 18th Century ?—There was a tremendous small-pox mortality in two periods which I have here— in the period from 1728 to 1757 it was 426 ; from 1771 to 1780, which was the middle of the inoculaticn