THE VACCINATION INQUIRER
AND HEALTH REVIEW
Sept-Oct 1952  No 817

President: MR ARTHUR TROBRIDGE  Treasurer: MAJOR HALL PARKE    Secretary:  MISS L. Loat

Medical Vice Presidents:

COMPULSORY VACCINATION IN SWEDEN
CONQUEST OF MALARIA IN THE COPPER BELT
B.C.G. VACCINATION NOT YET FOR COMMON USE

A startling fact!  In England & Wales in the 16 years ended Dec 1948, only 2 children (under 5) died of smallpox, but 72 died of vaccination in 1938, 1939, 1940, 1941 and 1942.  20 deaths were assigned to smallpox vaccination and none to smallpox (under 5). [Ref: Replies to Minister of Health, 13 July 1938, 23 Oct 1941, 11 Nov 1943, 24th Dec 1946, 23rd Sept 1948, April 11th 1949]

COMPULSORY VACCINATION IN SWEDEN (page 101-102)

Professor Emeritus in Medicine Israel Holmgren pgives reasons, in an article in the Swedish vegetarian magazine Waerland's Mdnada Magazin why the compulsory vaccination law is no longer necessary in Sweden.

While Professor Holmgren appears to share the views of the late Dr. C. Killick Millard, believing that vaccination protects against smallpox, his article is highly important.

An investigation of official reports on smallpox in Great Britain from 1922 to 1947 reveals that a majority of the alleged unvaccinated fatal cases of smallpox were old people. The first fatal case at Grimsby was aged 85. He had died and was buried before it was stated that he had died of smallpox. He was not exhumed to find out whether he had been vaccinated or not. It was assumed that he was unvaccinated. The second fatal case at Grimsby, aged 75, was also entered as unvaccinated, as were three other old men, aged 67, 79, and 70.  One, aged 78, who died was entered as vaccinated in infancy and again during the outbreak. The Medical Officer of Health admitted that most of these elderly people were suffering from some other disease which was the real cause of death, yet they were registered as unvaccinated smallpox fatalities and went to swell the unvaccinated fatality rate. One of the unvac­cinated fatal cases at Bilston was 69.

There were some extraordinary occurrences during the period under review. At Birkenhead (Rock Ferry) a man, his wife, and their four children developed smallpox and only the man, vac­cinated in infancy, recovered. The wife and three of the children had not been vaccinated. The youngest, a boy of 12, was quite well when taken to hospital and vaccinated.  He developed smallpox four days later and died. He is down as unvaccinated. An un-vaccinated girl in Essex developed smallpox and died. Two older relatives took it and recovered. Her brother, vaccinated after contact, developed small­pox some days later and died. He is down as un-vaccinated. Two other fatal cases in Essex-each, bore four marks of vaccination.

Some 20 of the fatal cases in the period under review had admittedly been vaccinated, and details are available of 24 "unvaccinated" fatal cases, some of whom had been vaccinated from four to tern days before smallpox developed. No argument in favour of vaccination can be based on such figures.

The argument that in the case of the vaccinated victims of smallpox vaccination had been performed more than twenty years before cuts no ice at all. Ex­cept for the armed forces and the police force, only infants are vaccinated in Great Britain, and during the thirty years preceding these smallpox outbreaks from one-half to two-thirds of the babies born had been exempted from vaccination. It was therefore extremely unlikely that of the very limited number of smallpox cases that occurred any of them would occur in persons vaccinated less than twenty years, previously. Some of the cases were people who had been successfully vaccinated up to fourteen days before smallpox developed, but these vaccinations are not considered by those who compile the official figures.

Swedish Records of Smallpox and Vaccination    

Returning to Professor Holmgren's article, the? Professor gives the Swedish records which show that^ the compulsory vaccination law was passed in 1816» but smallpox epidemics raged between 1847 and 1874. A new epidemic regulation came into force in 1875 which ordered the isolation of contagious diseases. During the period 1901-34 only 43 persons died of smallpox in Sweden. Since the beginning of this century smallpox has been a disease without any importance in Sweden. Professor Holmgren attributes this to their good organisation in regard to public health and medical attendance, with rapid isolation, disinfection, etc. The earlier smallpox epidemics continued for several years whereas nowa­days they die out after a few weeks or months.

Tn view of these facts Professor Holmgren says it is not fair to force the population to be vaccinated in childhood in order to meet a danger that might arise if one or a small number of smallpox cases came to the country from abroad.

He does not think the country can do without vaccination entirely. Those who have the care of smallpox cases should, he thinks, be vaccinated and those who have caught the infection from a sick person ought to a certain degree to be vaccinated. [Our friend's translation may not represent in English exactly what Prof. Holmgren means.—Ed.]

The Professor refers to the views held by some people that it is wrong in any circumstances to inoculate with a living contagion. They find it an intrusion contrary to nature, with far-reaching consequences for the body. He thinks this opinion is based on a misunderstanding. He thinks vaccination copies nature's methods, as he believes a light attack of a disease such as scarlet fever, measles or mumps gives protection against a more serious form of the disease later in their lives.

It might be interjected here (1) that vaccination is not a mild form of smallpox, and (2) that no statistical proof has been forthcoming that one attack of a disease prevents another in later life. So far as smallpox is concerned the late Professor Vogt compiled statistical tables which showed that there was more likelihood of a second attack of smallpox than of a first attack. Japanese records suggest the same.

The late Professor McIntosh condemned from the scientific point of view the use of a living virus, as in vaccination against smallpox. He believed that the cases of encephalitis that followed vaccination had actually been caused by the vaccination.

Publication of Professor Holmgren's article may eventually bring about the abolition of compulsory vaccination in Sweden. In Norway vaccination is not compulsory. Holland has an exemption clause in its compulsory vaccination Act. In Denmark children are not compelled to be vaccinated until they reach school age, and the law allows exemption in cer­tain cases. It would be a great step forward if Sweden abolished her vaccination law.

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HONG KONG

In an article on "Five Years' Progress in the Hong Kong Health Services" by I. Newton, F.R.C.S.Ed., Director of Medical and Health Services, Hong Kong, in the B.M.J., 27.10.51, it is stated that the Japanese, during their three-and-a-half years' occupation of Hong Kong had made no real attempt to deal with smallpox and cholera. Since the Japanese believe firmly in vaccination and all inoculations, it seems very unlikely that they stopped the vaccination service when they took possession of the Colony.

Dr. Newton says that there were probably little more than 600,000 people in Hong Kong when the war ended, but by August 1945 the population was 1,600,000 and in 1950 it was over 2,230,000, resulting in serious overcrowding. He writes:

Smallpox  and  cholera,  fed  by  the influx  of people during 1946, reached epidemic proportions, and in the winter of  1946-7 there  were   1,560 cases of smallpox, with 977 deaths. A vigorous vaccination campaign was instituted, and when the winter of 1947-8 arrived over 2,000,000 vaccinations had been done, and the population was largely immune. Since the spring of  1947, and in the three years 1947, 1948 and  1949, a total of only 52 cases have occurred. Many   hundreds   of   thousands   of   inoculations against cholera were carried out, and Dr. Newton claims   that   this   "combined   with   education   and regulations concerned with the protecion and handling of food, has undoubtedly played some part in the disappearance of the disease after the epidemic in 1946".

Many health administrations have little faith in cholera inoculation in the control of outbreaks. In all statistics put forward in its favour there are groups of inoculated persons who have died of cholera in spite of the inoculation. The Egyptian cholera out­breaks of 1947 were stopped by the provision of pure water to the areas in which the epidemic occurred. It can hardly be doubted that the suppression of both smallpox and cholera in Hong Kong was due to the sanitary regulations that were enforced and to the improvement in the food supply situation.

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CONQUEST OF MALARIA IN THE COPPER BELT

In Optima, a quarterly review published by the Anglo-American Corporation of South Africa, in the interests of mining, industrial, scientific and economic progress, Vol. 1, Number 3, December 1951, an article appeared on "Conquest of Malaria in the Copperbelt" by J. H. G. van Blommestein, D.S.O., M.B., Ch.B., D.P.H., D.T.M.&H.

Dr. van Blommestein tells an interesting story of how malaria has been controlled in the Northern Rhodesian Copperbelt. While he attributes the spread of malaria to the anopheles mosquito, he shows how sanitation and common sense have conquered the disease.

When the mining operations were started in virgin bush country where the only open areas were swamps or dambos, there was a large influx of Europeans and natives, and temporary housing had to be hastily provided. The majority of the temporary shacks erected were without mosquito-proofing. There were man-made excavations everywhere which, during the summer rains, accumulated sufficient water to make ideal breeding-grounds for the mosquitoes.

At first only the routine oiling of swamps in the vicinity of the camps was undertaken. At an early date quinine tablets were issued gratis to employees of the mining corporations.

Quinine prophylactic  measures nevertheless failed to stave off what eventually happens under conditions such as those prevailing at that time. The incidence of acute attacks of malaria among  the European population increased as time went on, and, in those who had been over-generous with  quinine  dosage,  there  developed a condition that was termed  "low fever." Among the lay population this "low fever" was supposed to bear no relation whatever to malaria. In fact, it was a form of suppressed malaria as a result of prolonged dosage of quinine.

 In order to assist the anti-malarial campaign, the residents,  by means of pamphlets, were asked  for their co-operation in assisting in the general hygiene of the camp. The menace of empty tins that had contained foodstuffs being discarded haphazard  in the bush round the houses was the cause of more worry to the health department than anything else —since the  tins  formed  ideal  breeding  places for the mosquitoes. After warnings and several prosecutions this nuisance gradually abated.

Other measures taken were the erection of permanent houses for Europeans with proper mosquito-proofing, the gradual demolition of all shacks in the vicinity of the camp, the digging of storm-water drains which were lined with brick or stone, the felling of trees in an unbuilt area in the vicinity of the camp, grass-cutting and the razing of all ant­hills.

"It was thus possible, upon completion of these precautionary measures, to maintain the area in a sanitary state and to fill in holes and inequalities 'in the contours that might otherwise have been potential breeding-places for mosquitoes."

As the population increased more ground had to be available for building, but that in the immediate vicinity of the camps was mostly marshland. It seemed at first that it would be impossible to achieve any form of drainage without involving the mining companies in very heavy expenditure, but a very satisfactory drainage scheme was adopted and on one of these reclaimed marshlands there now exists a large native village comprising some 2,000 houses.

Many of the natural streams in the neighbourhood have been canalised.

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B.C.G. VACCINATION NOT YET FOR COMMON USE

In a speech to the third Commonwealth Healti and Tuberculosis Conference in London (9.7.52) Mr. Iain Macleod, Minister of Health, said in reference to B.C.G. vaccination: "It is not yet felt that the time has come to make the vaccine available for general or indiscriminate use among the population at large. This view, although it may be thought unduly restrictive by some, is based on responsible expert judgment, and is not due to limitations of supply of the vaccine or to financial economy.