7/27/2019 Garrow Vax Unvax 1928 BMJ

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CORRESPONDENCE. [ Tmollal'l'UII -X&DIUL 30RII.AI.

4.olrtsponbtnrt.FATALITY RATES OF SMALL-POX IN 'l'HE

VACCINATED AND UNVACCINATED.Sm, - l t is an almost universal medical belief (and Ishare this belief) that th e fatality rate among personsattacked by small-pox il!l much greater, age for age, among:t4e unvaccinated than among th e vaccinated.An interesting contradiction is furnished in th e small

po statistics of England an d Wales fo r th e four years1923-26. 'l'he f o l l o w i ~ table furnishes th e uum.bers ofcases of " small-pox ' in vaccinated an d unvaecinatedpersons o\'er 15 years of age, together with the numbers ofdeaths an d th e fatality rates pe r cent., for each or theseyears an d fo r th e whole period. The comparison is confilled to age 15 &nrl .over for the simple reason thatpl'actically all th e cases under 15 are among th e unn ~ c c i u a t e d .

Va.ccin..ted. Unva.ceinated."f.e&r. Case I Casea.ses Over Deaths. :Mortality Cases Ovr Dea.ths. Morilllity15 Years. per cent. !5 Years. pe r cent.- -1923 369 2 0.5. 734 2 0.31924 635 z 0.3 1;241 - -1925 933 3 0.3 1,824 - -1936 2,073 6 0.3 *3,116 I 2 M6--- - - - I Iota.ls 4,010 13 0.3 6,915 4 0.06

Including 94 cues" doubtful" as to vaccina.tion stat e.I t will be observed that in each year the fatality ratewas greater amo11g .the v.accinated than .amoug th e un:v:a.ecmated. In a total for these years of 11,01.9 cases,4,910 nccuned among th e vaccinated, with l3 deaths-afatality rate -of 0.3 pe r cent.-and o;915 {)ccurred among:the unraccinated with 4 deaths-a fatality rate of 0.06 percent. That is to say, the fatality rate among raccinatedcases was just five times .as great as among unYaceinatedcases.I t :w:ould be inieresting to read possible exp:lanations ofthis. statistical .anomaly which y.our reade-rs m.ay hav-e toofF.er. Clearly soine explanation is required, ! l ~ d I suggestthat, in justice to n1.ccinati,_on, these figur-es call urgentlyfor: 1. A speeial inquiry into the hue cause of death ofall fatal cases oi " mild small-pox " in this oountry. 2. Revisiou of th e rules of death regiskati.ou under1\"hich a .death certified bv th e doctor in attendanceas du e to du:oi'lic uepluitfs, cerebral haemorrhage, orother disease or courution unconnected with .small-po.x,is t e g i s t e ~ e d and .ellt-ered in th e vital statistics as adeath from small-pox.j\'ote.-The .fig.ures qtu>ted .1u:e fJ:Om th e annual reports of theChief Medical Ofticer, Ministry -of Health, 1923 (p . 37), 1924 (p . 37),1925 (p . 38), 1928 {p. 39).-1 am, etc.,Obestet1icld, Jan. 4th. R. P. GARROW.

GAS GANGRENE FOLLOWING STREETACCIDENTS.-Bm, - I have read with interest the reports of two casesof ga.s gangrene following motor accidents, Dn. MarshallIIDti Ellis, in you issue .of December 24th, 1927 (pp. 1183&Dd 1184). I t ill :tG be regretted that both these articlesoonv.ey th e impre3Sioa that gas gangr-ene is very rare incivil. ,practice, whereas it is no t at all uncommon. - Indeed, in tw.o of th e hospitals with whiffi I am conDeC'bed th e hOUSEH!urgeons an d casualty officers ltave beentold to give pmphylactie injecti-ons of " anti-gas " S{'ruma.t th e same time as th e antitetanie in all ('-ases of streeta-coidents with badly lacerated wounds an d ~ ~ r u s h e d tissues. During the past year I have had to perf-orm three amputa~ O J U I and several le8Se!-' local operatiOns fo r suCh inrections.

Two points of special intetest ar e to be nuted, witltregard p a r t i c u ~ r l y to infecti.ons with B. welcldi: certaindistricts an d roads nppear to be much more heavily in fected than others (this corresponds to war-time experience,when wounds sustaiued iu certain very limited districtsdisp-layed a big incidence of gas gangrene, while tho8e fromareas two or three hundred yards away were practicallyfree); bacteriological investigation of a .series of stteetaccident wounds will reveal th e organism in a large percentage of cases, but in only oompamtively few of these a1'ethere any of th e clinical signs of infecti