Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
[Report of the Medical Officer of Health for London County Council]
The table shows that the unvaccinated population in London has in proportion to its size
contributed more largely to the admissions into the hospitals of the managers than the vaccinated
population ; that the unvaccinated smallpox patients are of younger age than the vaccinated, and that
the mortality of the former has been much greater than that of the latter.
I have in recent reports referred to the increasing proportion of children born in London, who
appear in the vaccination returns as " not finally accounted for," a proportion which has especially
increased during the period since the appointment of the Royal Commission on Vaccination. The
proportion in successive years has been as follows—
|Year.||Children not finally accounted for (including cases postponed) per cent. of total birtti8.||Year.||Children not finally. accounted for (including cases postponed) per cent. of total births.|
In my last report I published a table showing the proportion of such children in each of the
metropolitan unions in each year from 1881 to 1893 inclusive. No returns are as yet available which
supply later information, but I extract from the 26th annual report of the Local Government Board
the following paragraph—
With regard to the metropolis the returns for 1894 show that the number of cases not finally
accounted for as regards vaccination amounted to 20'6 per cent., whereas, in the previous year, the
percentage of default was 182. In several of the Unions the percentage of cases not finally accounted
for was exceedingly high. For instance, in Bethnal.green it was 64.4, in Hackney 57.0, in Mile.end Old
Town 53.0, in Shoreditch 33.9, and in Westminster 30.7. On the other hand the work of some of the
vaccination officers has been carried out so efficiently that the proportion of children escaping vaccination
has been comparatively low. Thus in 1894 the percentage of default in Woolwich, Whitechapel, St.
George Hanover.square, and Greenwich was 3.9, 5.1, 6.0, and 7.1 respectively.
Several of the annual reports of the medical officers of health contain tables exhibiting the
extent of vaccination default in the year 1895, and a comparison of these figures with those of previous
years shows that the amount of default in London was steadily increasing, the districts in which the
largest proportions of children "not finally accounted for" were found being Hackney, Mile.end Old.
town, Stoke Newington, and Lambeth. Probable explanation of this neglect may be found in the
following paragraph in the report of the Royal Commission—
(513.) We were anxious to learn to what extent the guardians in England and Wales had ceased to
put the law requiring the vaccination of children in force. We accordingly made inquiry of the
guardians throughout the country. Answers were received from 620 out of 618 Unions. We found that
the law was not being enforced in 122 out of the 620 districts; in 46 of the 122, however, the guardians
based their action upon the fact that a Royal Commission had been appointed to inquire into the subject
of vaccination, and had not yet reported.
The Royal Commission having recommended alteration in the law, this neglect to enforce
existing law will probably be continued until the subject has been dealt with by Parliament. The
need for the early consideration of this subject by the legislature is therefore very urgent.
In the year 1896 the Royal Commission on Vaccination presented its final report. I extract
from this report some of the more important conclusions of the Commission. Referring to vaccination
the report states—
(377.) We think:—
1. That it diminishes the liability to be attacked by the disease [smallpox].
2. That it modifies the character of the disease, and renders it (a) less fatal and (b) of a milder or less
3. That the protection it affords against attacks of the disease is greatest during the years
immediately succeeding the operation of vaccination. It is impossible to fix with precision the length of
this period of highest protection. Though not in all cases the same, if a period is to be fixed, it might,
we think, fairly be said to cover in general a period of nine or ten years.
4. That after the lapse of the period of highest protective potency, the efficacy of vaccination to
protect against attack rapidly diminishes, but that it is still considerable in the next quinquennium, and
possibly never altogether ceases.
5. That its power to modify the character of the disease is also greatest in the period in which its
power to protect from attack is greatest, but that its power thus to modify the disease does not diminish
as rapidly as its protective influence against attacks, and its efficacy during the later periods of life to
modify the disease is still very considerable.
6. That re.vaccination restores the protection which lapse of time has diminished, but the evidence
shows that this protection again diminishes, and that, to ensure the highest degree of protection which
vaccination can give, the operation should be at intervals repeated.
7. That the beneficial effects of vaccination are most experienced by those in whose case it has been