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The compulsory notification of infectious diseases in the metropolis
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THE
COMPULSORY N O T I F I C A T I O N OF
external conditions for infection and for death with the unvaccinated, being common inmates of the same infected houses. In this case the attack-rate of the vaccinated was 78 per thousand, of the unvaccinated 869 ; the death-rate of the vaccinated was i, of the unvaccinated 38t. Under these extreme yet identical circumstances, therefore, the vaccinated children had, as compared with the unvaccinated, an I i-fold immunity from attack by small-pox, and a 38 t-fold security against death by small-pox. (b) Next, concerning persons over IO years of age living in Sheffield during i887-8 , the attackrate in persons twice vaccinated was 3 per thousand, in persons once vaccinated I9, in persons not vaccinated 94. The death-rate among persons twice vaccinated was "08, among persons once vaccinated was x, the death-rate among persons not vaccinated was 5 I. Therefore, under the general ,circumstances of the Sheffield epidemic, the twiceVaccinated persons over io years of age, as compared with the unvaccinated persons of the, same age living in the town, had a 3x-fold immunity against attack by small-pox, and had a 64o-fold security against death by smaU-pox. Revaccination apart, the people over io years of age living under these general circumstances had, if they were vaccinated at all, a 5-fold immunity against death by small-pox compared with the unvaccinated people of the same age. Once-vaccinated people over to years of age constitute the great majority of the inhabitants of Sheffield. It is demonstrated by the above comparison that these people had lost a great measure o f the protection against small-pox which as children they once possessed, and that they had not acquired any such additional protection as was possessed by persons of their age who had undergone a second vaccination. (c) Influence of vaccination upon Sheffield people ot all ages: The attack-rate of the vaccinated was i5"5, the unvaccinated 97 ; the deathrate of the vaccinated was "7, the unvaccinated 48. Restricting the examination to the invaded households and in persons of all ages : Under these extreme conditions the attack-rate of the vaccinated was 23 ° per thousand, of the unvaccinated 75 ° per thousand; the death-rate in the vaccinated was i i, of the unvaccinated 372 . Wherefore under these extreme but identical conditions of small-pox infection people of all ages in Sheffield had, if they were vaccinated, a more than treble immunity against attack by small-pox, and a 34-fold security against death by small-pox, as compared with their not vaccinated fellow-residents in invaded houses. Dr. Buchanan sums up the history and teaching of the epidemic as follows : "There has prevailed in Sheffield during I887-8 an epidemic of smallpox, giving rise during the two years to z z ' 2 attacks and z'o7 deaths per thousand population of all ages. Up to the period (March 3Ist, i888) when i9' 3
I N F E C T I O U S DISEASES.
per thousand attacks and r'87 per thousand deaths had taken place, this epidemic was carefully studied by Dr. Barry. It has been found that if so-called 'sanitary circumstances' have had any influence at all upon the rate of attack and death, such influence is not demonstrable, and can, at the utmost, have been but small. It has been found that the borough hospital is accountable for a special prevalence of small-pox upon central Sheffield, and it must remain under suspicion of having helped to magnify the epidemic in the town. It has been found that the children of Sheffield have had a far smaller death-rate from small-pox than in previous epidemics, and that they have during x887-8 borne a quite inconsiderable share of the total small-pox attacks and mortality--a share vastly less than that ever borne by the children of earlier periods; and that, seeing what we do of the protective value of infantile vaccination during this epidemic, this circumstance cannot but have been due to the more general performance of vaccination in infancy. It has been found that people over Io years of age in Sheffield have, on the contrary, experienced an actual rise on their previous small-pox death-rate, and that these people have borne during the recent epidemic a quite extravagant share of small-pox attacks and mortality. It has been found that, in spite of this rise, the whole population has now-a-days, owing solely to the enormous reduction of the death-rate in children, a small-pox death-rate of 72 per cent. below its former amount. It has been shown that where people over ~o have undergone a second vaccination they have recovered the immunity from smallpox which they had as children."
T H E COMPULSORY N O T I F I C A T I O N OF I N F E C T I O U S DISEASES I N T H E METROPOLIS. IT has been referred to the Sanitary Committee of the London County Council to consider and report on the desirability of a bill being introduced to compel the registration by all medical practitioners of every case of infectious disease which they are called upon to treat ; such registration to be at the office of the local authority. It is a grievous anomaly that the largest population centre should have less protection than the smaller population centres, and there can be little doubt that any reasonable bill drawn upon the lines which have been so successful in northern and midland counties would be favourably considered by both sides of the House and become law. On the other hand there is much to be said against piecemeal legislation. The proper course to treat the subject would be for the Government to bring in a dual and compulsory notification bill for the whole
country.
THE
COMPULSORY N O T I F I C A T I O N OF
external conditions for infection and for death with the unvaccinated, being common inmates of the same infected houses. In this case the attack-rate of the vaccinated was 78 per thousand, of the unvaccinated 869 ; the death-rate of the vaccinated was i, of the unvaccinated 38t. Under these extreme yet identical circumstances, therefore, the vaccinated children had, as compared with the unvaccinated, an I i-fold immunity from attack by small-pox, and a 38 t-fold security against death by small-pox. (b) Next, concerning persons over IO years of age living in Sheffield during i887-8 , the attackrate in persons twice vaccinated was 3 per thousand, in persons once vaccinated I9, in persons not vaccinated 94. The death-rate among persons twice vaccinated was "08, among persons once vaccinated was x, the death-rate among persons not vaccinated was 5 I. Therefore, under the general ,circumstances of the Sheffield epidemic, the twiceVaccinated persons over io years of age, as compared with the unvaccinated persons of the, same age living in the town, had a 3x-fold immunity against attack by small-pox, and had a 64o-fold security against death by smaU-pox. Revaccination apart, the people over io years of age living under these general circumstances had, if they were vaccinated at all, a 5-fold immunity against death by small-pox compared with the unvaccinated people of the same age. Once-vaccinated people over to years of age constitute the great majority of the inhabitants of Sheffield. It is demonstrated by the above comparison that these people had lost a great measure o f the protection against small-pox which as children they once possessed, and that they had not acquired any such additional protection as was possessed by persons of their age who had undergone a second vaccination. (c) Influence of vaccination upon Sheffield people ot all ages: The attack-rate of the vaccinated was i5"5, the unvaccinated 97 ; the deathrate of the vaccinated was "7, the unvaccinated 48. Restricting the examination to the invaded households and in persons of all ages : Under these extreme conditions the attack-rate of the vaccinated was 23 ° per thousand, of the unvaccinated 75 ° per thousand; the death-rate in the vaccinated was i i, of the unvaccinated 372 . Wherefore under these extreme but identical conditions of small-pox infection people of all ages in Sheffield had, if they were vaccinated, a more than treble immunity against attack by small-pox, and a 34-fold security against death by small-pox, as compared with their not vaccinated fellow-residents in invaded houses. Dr. Buchanan sums up the history and teaching of the epidemic as follows : "There has prevailed in Sheffield during I887-8 an epidemic of smallpox, giving rise during the two years to z z ' 2 attacks and z'o7 deaths per thousand population of all ages. Up to the period (March 3Ist, i888) when i9' 3
I N F E C T I O U S DISEASES.
per thousand attacks and r'87 per thousand deaths had taken place, this epidemic was carefully studied by Dr. Barry. It has been found that if so-called 'sanitary circumstances' have had any influence at all upon the rate of attack and death, such influence is not demonstrable, and can, at the utmost, have been but small. It has been found that the borough hospital is accountable for a special prevalence of small-pox upon central Sheffield, and it must remain under suspicion of having helped to magnify the epidemic in the town. It has been found that the children of Sheffield have had a far smaller death-rate from small-pox than in previous epidemics, and that they have during x887-8 borne a quite inconsiderable share of the total small-pox attacks and mortality--a share vastly less than that ever borne by the children of earlier periods; and that, seeing what we do of the protective value of infantile vaccination during this epidemic, this circumstance cannot but have been due to the more general performance of vaccination in infancy. It has been found that people over Io years of age in Sheffield have, on the contrary, experienced an actual rise on their previous small-pox death-rate, and that these people have borne during the recent epidemic a quite extravagant share of small-pox attacks and mortality. It has been found that, in spite of this rise, the whole population has now-a-days, owing solely to the enormous reduction of the death-rate in children, a small-pox death-rate of 72 per cent. below its former amount. It has been shown that where people over ~o have undergone a second vaccination they have recovered the immunity from smallpox which they had as children."
T H E COMPULSORY N O T I F I C A T I O N OF I N F E C T I O U S DISEASES I N T H E METROPOLIS. IT has been referred to the Sanitary Committee of the London County Council to consider and report on the desirability of a bill being introduced to compel the registration by all medical practitioners of every case of infectious disease which they are called upon to treat ; such registration to be at the office of the local authority. It is a grievous anomaly that the largest population centre should have less protection than the smaller population centres, and there can be little doubt that any reasonable bill drawn upon the lines which have been so successful in northern and midland counties would be favourably considered by both sides of the House and become law. On the other hand there is much to be said against piecemeal legislation. The proper course to treat the subject would be for the Government to bring in a dual and compulsory notification bill for the whole
country.