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147
or the nature of an illness, is sometimes obscure, and even if its
nature be known, it may be difficult to ascertain with certainty
what has been its origin. We shall have to make further reference
presently to the difficulties which must needs be encountered
in the investigation upon which we are engaged. As we have
already stated, it is not open to doubt that there have been cases
in which injury and death have resulted from vaccination.
In the years 1859-67 the deaths returned as due to erysipelas
after vaccination varied from 2 to 13; the annual average being
6.8. From 1868-71 inclusive they varied from 9 to 24; the
annual average being 18.0. From 1859-71 the population of
England and Wales had increased from 19 to 22 millions. Inaddition
to this there can be no doubt that the number of children vaccinated
increased very much between 1868 and 1871, as compared
with the previous period, owing to the legislation of 1867. Of
course, the greater the number of the vaccinated amongst the
children born in any given period the greater, cateris paribus, would
be the number of cases of erysipelas after vaccination, without
any necessary connection between the two. The same remark
applies to the period between 1872 and 1880, when the cases
returned as erysipelas after vaccination varied from 16 to 39 ; the
annual average being 28.5. The Act of 1871 undoubtedly
increased largely the number of infantile vaccinations in this period
as compared with that which preceded it. In subsequent years
erysipelas after vaccination was not separately recorded, being
included under the heading "cow-pox and other effects of
vaccination." There were 283 such cases in the years 1881-1885.
During the years 1886 to 1891 the cause of death was in 279
cases certified as connected with vaccination. Many of these
cases were the subject of special inquiry by the Local Government
Board. We have had before us a summary of the reports made
to the Board of the results of such inquiries, prepared for us by
Dr. Acland and Dr. Coupland. The reports referred to cover the
period from the 1st of November, 1888, to the 30th of November,