LIST OF WITNESSES. A. E. Brindley, Esq., M.D., B.Sc., D.P.H. Medical Officer of Health, Derby. Joint Lecturer on Public Health, University of Manchester. John Brownlee, Esq., M.A., D.Sc., D.P.H. Director of the Statistical Department, National Institute for Medical Research. (Since deceased.) A. F. Cameron, Esq., M.A., M.D., D.P.H. Medical Superintendent, River Hospitals and Ambulance Service, Metropolitan Asylums Board. Captain S. R. Douglas, M.R.C.S., F.R.S., I.M.S. (retd.) Director of the Department of Experimental Pathology and Bacteriology, National Institute for Medical Research. A. Drury, Esq., M.B., C.M. Public Vaccinator, Halifax Union. (Since deceased.) R. P. Garrow, Esq., M.D., D.P.H. Medical Officer of Health, Chesterfield. Major-General D. S. Harvey, C.M.G., C.B.E., M.D. Director of Patho logy, War Office. R. W. Jameson, Esq., M.D., M.R.C.S., D.P.H. Late Assistant Medical Officer for smallpox purposes, Gloucester. C. Killick Millard, Esq., M.D., D.Sc. Medical Officer of Health, Leicester. Wm. McConnel Wanklyn, Esq., M.R.C.S., D.P.H. Assistant Medical Officer, London County Council. Consultant in diagnosis of smallpox, London, Middlesex and Essex County Councils. CONTENTS. PART I. Page. Reference i: On matters relating to the preparation, testing and standardi- ... The Royal Commission and the use of calf lymph The origin of vaccine lymph Maintenance of quality ... ... ... 9 9 9 11 12 12 The Government Lymph Establishment technique and procedure at, On the practical methods which are available in the light of Brief review of the work of the Royal Commission Table I.-England and Wales. Table showing the number of The appearance of diseases of the central nervous system 24 On the methods of vaccination which are most appropriate to A 3 The clinical course of primary vaccinia in the resting adult male. ... PART II. DISEASES OF THE CENTRAL NERVOUS SYSTEM FOLLOWING VACCINATION Report of the Committee presided over by Sir Frederick Andrewes (May, 1925) 89 90 129 ... ... Particulars of cases considered by the Andrewes Committee ... ... ... ... ... 145 146 Vaccination of cases: primary or secondary, lymph used ... A brief comparison of certain epidemiological features common to the British and Dutch cases 150 150 The hypothesis of activation of a neurotropic virus by the virus ... A commentary on the Report of the Andrewes Committee ... Experimental data bearing on the problem of post-vaccinal encephalitis. Analysis of certain recorded data On the possibility of producing fatal encephalitis or other The mutual interaction of viruses. Ad hoc experiments cases ... ... ... ... Demonstration of vaccine virus in organs and central nervous ... Experiments on rabbits and monkeys with a view to demon- Summary and recommendations... ... Experimental studies of vaccinia virus in relation to encephalitis. ... ... Page. 192 194 197 199 203 APPENDICES. PART I. Appendix 1.-Particulars of deaths returned as "41 (1) Vaccinia" in the Registrar-General's Statistical Review, 1911-1925. Appendix II.-Particulars of cases, including deaths, associated with vaccination, but not returned as "41 (1) Vaccinia" in the RegistrarGeneral's Statistical Review, 1911-1925. Appendix III.-An inquiry into illnesses occurring within three months after vaccination in vaccinated cases and in unvaccinated controls, by George F. Buchan, M.D., M.R.C.P., D.P.H. Appendix IV.-Report on the result of the analysis of the post-vaccinal medical history of 753 boys in a residential institution. Appendix V.-Observations on the vaccination of adult males. Appendix VI.—The clinical course of primary vaccination in the resting adult (with three charts). Appendix VII.-Table showing the relationship between the severity of the general reaction as indicated by the temperature and that of the local reaction as shown by the extent of the area of redness and the vesicular area. Appendix VIII.-Chart to contrast the highest four-hourly temperature of 24 hours in men resting with that of men doing two hours' physical exercise daily. Appendix IX.-Chart to contrast the rate of development of the vesicles in men resting with that of men doing two hours' physical exercise daily. Appendix X.-Tables and charts to contrast the average daily area of areola and vesicles, and the average daily maximum temperature in six-mark and two-mark vaccinations. Appendix XI.-Tables and charts to contrast the average daily area of areola and vesicles, and the average daily maximum temperature in Type 1 and Type II inoculations. 65887 A 4 PART II. Appendix XII.-Diagram showing (1) lymph issued for public vaccination, (2) number of cases of poliomyelitis and polio-encephalitis, (3) number of cases of encephalitis lethargica, and (4) number of cases of smallpox, in relation to the six cases of "post-vaccinal" diseases of the central nervous system which were reported in 1924 and 1925. Appendix XIII.-Summary of information received since the publication of the Committee's request in the medical press in April, 1926. Appendix XIV.-Chart showing time incidence of 25 cases of " 'postvaccinal" diseases of the central nervous system. Appendix XV.-Diagram showing details as in Appendix XII in relation to the 25 cases of "post-vaccinal" diseases of the central nervous system which were reported January, 1926-October, 1927. Appendix XVI.-Table showing the relation between the single cases of " post-vaccinal" diseases of the central nervous system and the notifications of (1) poliomyelitis and polio-encephalitis, (2) encephalitis lethargica and (3) smallpox from the same sanitary districts. Appendix XVII.-Sheffield C.B. and certain urban districts in Monmouthshire and Glamorganshire. Table showing the relation between groups of cases of "post-vaccinal " diseases of the central nervous system and the notifications of (1) poliomyelitis and polioencephalitis, (2) encephalitis lethargica, and (3) smallpox, and also (4) lymph issued for public vaccination, in these areas. Appendix XVIII.-Analysis of symptoms and physical signs exhibited by the "homogeneous group (47 cases) of the Andrewes Committee and the 25 cases of the present series. |