London's Pulse: Medical Officer of Health reports 1848-1972

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Islington 1867

[Report of the Medical Officer of Health for Islington, Parish of St Mary]

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5
small-pox kills a good many of those it attacks, but it disfigures nearly all, and
sometimes lays the foundation for other maladies which sooner or later make their
appearance. I will not refer to statistics gathered from outside our own boundary, but
will ask simply what our own Tables tell us upon the subject. During the five years,
1863-7, 330 persons have died from small-pox, 140 of them in the first five years of
their life, and 123 at 20 years of age and upwards, the remaining smaller proportion
of 67 during the fifteen years of life between five years of age and twenty. Now I do
not deny, and do not wish to deny, that generally our population is a vaccinated
population ; were it not so, the disastrous year 1863, and the ravages of small-pox
since would have been far more serious than they were. But, for all that, vaccination
is not so universal as it ought to be. Of our poor child population about 10 per
cent. is un-vaccinated up to the time of their leaving school, and we all know how
careless people become afterwards in a matter which is popularly regarded as one
which concerns children and not grown-up folk. And yet it does concern grown-up
folk, or else why the large proportion of 123 out of 330 deaths happening at twenty
years of age and upwards—not much less a number than the 140 dying from smallpox
under five years of age. Nor do I deny, or wish to deny, that a goodly number
of those who died from small-pox, especially amongst the adults, were vaccinated
persons, but the larger number, especially amongst the children, had not been
vaccinated at all. Indeed, this is one point that I desire rather to dwell upon, for it
has been used as an argument in favour of not compelling parents to obtain for their
children the protection of vaccination. Here, it may be said, is a number of persons,
vaccinated in their infancy, who, notwithstanding their vaccination, catch small-pox
and die from it. Why, then, insist upon the vaccination at all if it does not protect
them from the very casualty which it is asserted to protect from ? But is it true
that it does not protect? Will the adducing of any number of instances of fatal
small-pox after vaccination prove that it does not protect unless it be known also how
many persons have been vaccinated, and, under similar exposure, have escaped
contagion? For it may turn out that of 1000 vaccinated persons, only a small
proportion catch small-pox afterwards, and this for reasons which are quite easy of
explanation; while out of another 1000 who have not been vaccinated, very many
catch small-pox and die from it, while a much smaller proportion escape than of the
vaccinated. And it may turn out on enquiry, moreover, that the disease, when, from
some defect of the vaccination, from some influence of age, or from some peculiarity
of individual constitution, it attacks the vaccinated, is a less serious and fatal disease
than when it seizes upon the un-vaccinated. And what I have thus stated as possible
is indeed the true statement of facts. There is an abundance of statistics, gathered
from all parts of the world, to prove it so, if this were the place to adduce them. In
one continental city, where an accurate record was kept for twenty-one years, it was
found that one case of small-pox only occurred among each 367 vaccinated persons,
while one case occurred among each 12 of un-vaccinated persons; and further, that
while one fatal case occurred amongst each 7166 vaccinated persons, ono fatal case