HOW LEICESTER DEALS WITH VARIOLOUS OUTBREAKS.

(APPENDIX to  LEPROSY AND VACCINATION by  WILLIAM TEBB)

The success of what is known as the "Leicester Experiment" has created considerable public interest both at home and abroad,. and, in response to repeated inquiries, I am able to furnish the following particulars from the pen of Mr. Councillor Biggs, of Leicester. Mr. Biggs was for several years a member of the Board of Guardians, and is now a member of both the Sanitary and SmallPox Hospital Committees. He has had much to do with the substitution of sanitary amelioration and isolation for the now discarded system (so far as Leicester is concerned) of vaccination.

Our procedure in the notification of a case of small-pox may (he says) be described in the words of our Chief Sanitary Inspector,. Mr. F. Braley : —"When a case is reported, I at once go to the infected house, and try to ascertain where the disease was contracted, where the patient has been working, where he has been visiting, and his movements generally for the last ten or twelve days. I also make a point of seeing all persons who have visited the infected house during the time stated; in addition, I visit all factories and workshops where other members of the family have been employed; and by this-means have been able to get cases removed when the first symptoms of the disease appeared.

"Immediately on the removal of the patient, I superintend the fumigation of the house with sulphur; liquid disinfectants are used freely in the drains and about the yard, and the ashpit is emptied and disinfected; the next day the bedding is taken to the disinfecting chamber and subjected to the hot-air process.

"Up to the present time I have succeeded in getting almost every person connected with the infected houses into quarantine. In a very few cases I have experienced opposition.

"The above represents practically all we do of a special character beyond the ordinary treatment in cases of supposed infection. Those who are prevailed upon to go into quarantine usually remain for fourteen days, the period within which. small-pox issupposed to incubate after infection. So far from the authorities having to resort to harsh measures to enforce quarantine, this period of rest is made to be of so pleasant and. agreeable a character that, at its expiration, many have been reluctant to leave the hospital.

VACCINATION OPTIONAL.

"This fact disposes of an accusation which is constantly being hurled at Leicester, namely, that we not only forcibly seize those who have been in contact with small-pox cases, and compulsorily detain them in quarantine, but that, whilst they are there, we compel them to submit to vaccination or re-vaccination.

"Let us examine as to how far this favourite theory of our opponents has any foundation in fact.

"Of fifty-five persons who voluntarily went into quarantine during the three years a 1886-88, only twelve were vaccinated or re-vaccinated whilst in quarantine. If to these twelve we add three others who underwent the operation immediately before entering the hospital, there remain forty persons, or, 72.7 per cent, of the above fifty-five, who were neither vaccinated nor re-vaccinated during the quarantine period.

"Applying the same percentage to the 128 persons quarantined before a 1886, we find a further number of thirty-five persons who voluntarily submitted to the operation, who, when added to the other fifteen, make only fifty for the extended period. Thus, out of a total number of 183 persons who have passed through the quarantine wards .since the introduction of this system in 1877, no fewer than 133 were neither vaccinated nor re-vaccinated whilst in the hospital.

"During this period from fifteen to twenty persons absolutely refused to go into quarantine at all, and we had no power to compel them.

"Nearly all those who were quarantined belonged to the poorest classes, and to these a fortnight’s holiday with free board and good, if not comparatively luxurious, living, would prove to be no mean attraction. Those who had good homes remained there in preference to going to the hospital. Thus no infringement whatever of personal liberty has taken place against those who have put themselves for a time under the ‘Leicester Method’ of treatment; unless indeed, the gastronomic allurements above referred to might have proved an inducement to some to voluntarily yield up their personal liberty for a time.

SUCCESS OF THE LEICESTER METHOD

"After the subsidence of the great small-pox epidemic of 1871-73, which caused 360 small-pox deaths, when the town was thoroughly well vaccinated, up to the year 1889, which was the last year for which I could prepare statistics for the Royal Commission on Vaccination—that is, during the sixteen years from 1874 to 1889, inclusive—no fewer than thirty-three importations—mostly from well-vaccinated districts—and a large number of successive outbreaks of small-pox, were successfully stamped out. The town was thus saved from the further spread of the disease, with its possible ravages, by the ‘Leicester Method’ of treatment, without recourse to vaccination, and also without the slightest approach to arbitrariness on the part of the authorities, or any infringement of personal liberty.

ECONOMY OF THE "LEICESTER METHOD."

"It is sometimes assumed that this ‘Leicester Method’ of isolation, quarantine, disinfection, and sanitation is so expensive as to be practically prohibitive.

"On the contrary, our ‘Leicester Method’ is extremely economical as well as effective. Besides, it is now well-known that, however thoroughly a community is vaccinated, so little reliance is placed upon this supposed safeguard, that on the outbreak of small-pox recourse is at once had to the very measures which have been so persistently decried when used to the salvation of unvaccinated Leicester.

"From 1874 to 1889 the cost of public and private vaccination at Leicester was not far short of 10,000 (being about 9,818 2s. 11d.). During the same period the cost of quarantine, including compensation for destruction of infected clothes, bedding, disinfectants, etc., was under the modest sum of 500 (or about 488 l1s. 2d.). This represents a saving in favour of our Leicester method, as against vaccination, of over 9000 in the course of sixteen years. This 9000 was completely thrown away, to say nothing of the impaired vitality and spread of disease which vaccination necessarily implies. The 500 cost of quarantine, etc., did all the effectual work of saving the town from the ravages of small-pox threatened by the thirty-three importations, and absolutely averted the real danger implied by the occurrence of 116 small-pox cases in the midst of our crowded population.

JUSTIFIED BY RESULTS.

"Perhaps it will not now be out of place to briefly enumerate the substantial reasons which justify the Leicester people in the course they have pursued in respect to vaccination, and in adopting sanitation as their defence in the conflict with zymotic disease.

"Taking the groups of years dealt with by me before the Royal Commission on Vaccination, our average annual small-pox death-rate during 1853-57, with a moderate amount of vaccination, was only 91 per million population. But when vaccination had been continually and largely practised for a quarter of a century, and had reached over 90 per cent. to the annual births, and when, of course, its assumed protective power should have been greatest, our small-pox death-rate had progressively risen to an annual average of 773 per million population in 1868-72. Since that time vaccination has rapidly declined in the Borough, now being only about 2 per cent. Of the births, and small-pox mortality has disappeared from our midst.

SAVING OF LIFE IN LEICESTER.

"Our death-rate from the seven principal zymotic diseases, namely, small-pox, measles, scarlet fever, diphtheria, whooping-cough, common fevers (typhus, typhoid, and continued fever), and diarrhea, averaged annually for the five years 1868-72 no fewer than 6852 per million living, with over 90 per cent, of primary vaccinations to births. This is the highest vaccination rate and zymotic death-rate we have ever had recorded for Leicester. In 1888-89, when primary vaccinations were only about 5 per cent, of the births, the zymotic death-rate had fallen td only 2304 per million. On our Leicester population alone this would mean a saving of nearly 680 lives each year.

"Without going into unnecessary details, I may observe that the improvement in our general death-rate amongst children shows equally remarkable results. With over 90 per cent, of primary vaccinations to births in 1868-72, our death-rate from all causes, of children under five years of age, was 107; under ten years, was 61 ; and under fifteen years was 45 per 1000 living under each of those ages respectively. While in 1888-89, with only about 5 per cent. of primary vaccinations to births, each of these death-rates had fallen enormously. The death-rate under five years had declined to 63, that under ten years to 35, and that under fifteen years to 25 per 1000 living at each of the given ages respectively.

"This would represent a saving of about 880 lives under five years, of about 988 lives under ten years, and of about 1080 lives under fifteen years of age, inclusive and respectively for each year in Leicester.

"When it is remembered that the claim put forward for vaccination is its preservation of the younger lives, especially those under five years of age, the life-saving result of the ‘Leicester method,’ as shown above, is particularly striking. And it proves, unmistakably, that our watchword, ‘Sanitation,’ carries with it far more potency to deal with zymotic disease and with small-pox than the now discredited cry of ‘Vaccination.’

THE GENERAL HEALTH OF LEICESTER.

"Once more our general death-rate, that is, our death-rate from all causes and at all ages, gives results no less important. In 1868-72, when vaccination had reached its climax in Leicester, our death-rate was about 27 per 1000 of the living population, being nearly 5 per 1000 above the general death-rate for all England and Wales. In 1888-89, when vaccination had virtually ceased to be practised in the town, notwithstanding our disadvantageous geological and geographical position, in a valley, with one of the most sluggish rivers in England and a clayey and impervious water-logged subsoil, our incomplete, and therefore inadequate, drainage, our death-rate had fallen so rapidly, with declining vaccination, that it had actually fallen below the general death-rate of England and Wales. The death-rate for England and Wales was 17.9 for 1888-89, and that for Leicester 17.5, or 5.1 gain in favour of Leicester in less than twenty years.

These figures as compared with times of high vaccination mean an additional saving of about 1400 lives each year in Leicester alone, above the normal rate of saving in England and Wales. If this extra gain could be similarly achieved by the cessation of vaccination in the population of the whole country, other things being equal, it would mean an enormous saving of life beyond that which has actually been effected. The population of the United Kingdom for 1888-89 was estimated by the Registrar-General to be over 37,000,000. On this population an annual saving of about 189,000 lives would be effected. Even allowing an ample margin for possible errors in the calculations of the Registrar-General, these figures are sufficiently momentous to claim serious consideration.

"When it is borne in mind that England and Wales include all the rural districts, where the death-rate is very low, and that here our people are chiefly an artizan and manufacturing population whose circumstances are ever inimical to the health of the younger lives, Leicester’s progress from being one of the unhealthiest of towns to its present proud position must be acknowledged to be marvellous.

"With such remarkable results before us, the Leicester people can calmly await the verdict of thoughtful minds, assured that their course of action in rejecting vaccination, and their reliance upon sanitation, will in the long run break down existing prejudice, and that it will ultimately receive general approval and adoption."

It need only be added that a full report of the Leicester system has been presented by Mr. Biggs before the Royal Commission on Vaccination, which will be found in the fourth report of the evidence.

Appendix  Index