§ Order for Committee read,
MR. H. A. BRUCE
said, that before moving that the Deputy Speaker do leave the Chair, perhaps it would be convenient that he should make some statement to the House as to the scope of the Bill under consideration, not having had that opportunity on the second reading. He should not have allowed the Bill to reach this stage without that statement had he thought it involved any important new 1094 principle; but, although there appeared to be an apprehension that some new principle was involved in it, that was altogether a delusion. The Bill in the first place was a consolidation of the Acts which related to vaccination It consolidated provisions which were now dispersed over six different Acts of Parliament. It also introduced some Amendments, which he would explain to the Committee; but, before doing so, as the subject of vaccination had not for some time been discussed in the House, he would give a short and rapid sketch of what had been the course of legislation regarding it, and the effect on the public health at each stage of progress. The first attempt to deal with the enormous evils of small pox was made by Lady Mary Wortley Montagu in 1718. Inoculation was first tried on seven condemned criminals; and the result being satisfactory, in 1722, two of the Royal Family were, by the order of King George I., inoculated. Its success being placed beyond all doubt, inoculation for some time became very popular; but it was discovered that every inoculated person while labouring under the disease was himself the centre of infection, and Sir Gilbert Blane calculated that the effect of inoculation had been to raise the percentage of deaths in small pox from 74 to 92 per cent per thousand of the total mortality. But at the close of last century, Dr. Jenner made his immortal discovery, by which, perhaps, more misery had been prevented by the alleviation of pain and the preservation of life than by any other discovery that had ever been made. In 1802, a Committee was moved for in that House to inquire into the value of Jenner's discovery. They made a Report, in which they expressed a very strong opinion of its merits. In 1806, Lord Lansdowne, being then Chancellor of the Exchequer, moved an Address to His Majesty, praying that the College of Physicians might be requested to make further inquiries. They took twelve months to do so. They consulted all the chief medical bodies of Scotland, England, and Ireland, and presented a most able Report, to the effect that the discovery was a most valuable one, that it might be safely applied, that its effects were wholly advantageous, and in no respect injurious. In 1808, the first action of Parliament was taken. The National Vaccine Establishment was founded, and the sum of £2,000 a year had from that day to this been voted to it. Nothing 1095 further was done by Parliament, the matter being left to voluntary agency, till 1840, when the 3 & 4 Vict, was passed, which made vaccination optional, and authorized the payment of the public vaccinator by the Board of Guardians. That continued, with what effects he would proceed to describe, up to 1853, when the present legislation came in force. The compulsory Act of 1853 was introduced, not by Her Majesty's Government, but by Lord Lyttelton. It was carried through the House of Lords without a division; and was introduced here by the right hon. Baronet the Member for Droitwich (Sir John Pakington). Again, it was carried without a division, and had been the law of the land ever since. From time to time, since the passing of the Act, there had been occasional protests against it, not proceeding from any public body, but from individuals who objected on principle to vaccination. Then came the inquiries which were instituted by Sir Benjamin Hall. He directed a Report to be prepared by Mr. Simon, whose work was the standard work on this subject—a work conveying the fullest instruction in a most interesting form. Mr. Simon had in 185G referred four questions to all the medical societies in Europe, to all the principal foreign Governments, and to 542 physicians of different countries, selected on account of their known eminence and experience. With the permission of the House, he would read these Questions and Answers. The first Question was this—Have you any doubt that successful vaccination confers on persons subject to its influence a very large exemption from attacks of small pox, and almost absolute security against death by that disease?Their Answers to that Question 540 were distinct in having no doubt. One distrusted vaccination, but would gladly inoculate his own children with small pox. The other (Dr. Hamernik, of Prague) regarded both inoculation and vaccination at best but harmless trifling. The second Question was—Have you any reason to believe or suspect that vaccinated persons, in being rendered less susceptible of small pox, become more susceptible of any other infective disease or of phthisis, or that their health is in any other way disadvantageously affected?In reply to this, not one maintained that any injury arose from vaccination properly administered. Mr. Stone gave the following statistics of Christ's Hospital for more 1096 than a hundred years:—Average of boys during first fifty years, 550; during last fifty years, 800. In the first period, during which none were vaccinated, there were thirty-one deaths from small pox. In the last period, from 1801 to 1850, in which all were vaccinated, one only had died of small pox. The annual death rate from other diseases in hospital had greatly diminished. The third Question was—Have you any reason to believe or suspect that lymph from a true Jennerian vesicle has ever been a vehicle of syphilitic, scrofulous, or other constitutional infection to the vaccinated person, or that unintentional inoculation with some other disease, instead of the proposed vaccination, has occurred in the hands of a duly educated medical practitioner?To this all but a very few answered in the negative. The fourth Question was—Do you (assuming due provisions to exist for a skilful performance of the operation) recommend that, except for special reasons in individual cases, vaccination should be universally performed at early periods of life?All but two were favourable. He thought the House would see this inquiry was as exhaustive and complete as ingenuity could devise. But what had been the effect on the public health? Sir Gilbert Blane had stated that, so far as could be ascertained, the average annual death rate in small pox in England and Wales during thirty years previous to the introduction of vaccination was 3,000 per million of the population. The average of three years (1838 to 1840), when vaccination had become to a great extent diffused, but before any public provision was made for its gratuitous performance, was 770. The average of nine of the years (1841 to 1853) when public vaccination was gratuitously provided, but vaccination was not obligatory, was 304 per million. The average of the ten years (1854 to 1863) during which vaccination had been to a certain extent obligatory, was 171; and if the last year for which Returns had been made were included, the rate, instead of 171, would be 190 per million. One reason for these inquiries was the alarming increase which had taken place during the last few years in the deaths by small pox in England and Wales. In 1861 the number of deaths had fallen to 1,320, but rose in 1863 to 5,964, and in 1864 to 7,684. The House must recollect that these deaths by no means represented the evil inflicted on society by this dreadful scourge. A distinguished French physician, M. de la Condamine, in 1756, 1097 calculated that about one-fourth of the human race were suffering more or less from the effects of small pox, which showed themselves in blindness and deafness, entire or partial, scrofula, and other terrible forms of disease. With respect to the mortality among the vaccinated and un-vaccinated, the evidence was very complete. Perhaps the most capable witness on this point was Mr. Marson, for very many years in charge of the Small pox Hospital. Mr. Marson stated his conclusion, the result of 15,000 cases, in these words—That the fatality of small pox, when it attacks the unvaccinated, is 350 per 1,000; that its fatality to such vaccinated persons as it infects is, taking them indiscriminately, 70 per 1,000; but, distinguishing vaccinated persons into two classes, those (1) who have been vaccinated in the best known manner, and those (2) who have been badly vaccinated, the fatality of small pox, if it infects the former, will be 5 per 1,000; if it infects the latter, 150 per 1,000; that the risk of the one will be thirty times the risk of the other.Or, to state it differently, if attacked by small pox, one in three unvaccinated would die; one in seven imperfectly vaccinated; while only one in 200 would die if well vaccinated. But Mr. Marson's observations do far more than establish in a general way, in concurrence with others, the modifying power of vaccination. They have a merit peculiarly their own. They show conclusively that the degree of modifying power is in the exact ratio of the excellence and completeness of the vaccination as shown by the cicatrices; in other words, that it was directly as the amount of vaccine-marking and as the character of the marks. The following would show this at a glance better than any detailed statement:—Number of deaths per cent in each class respectively—1. Unvaccinated, 37. 2. Stated to have been vaccinated, but having no cicatrix, 23.57. 3. Vaccinated—having one vaccine cicatrix, 7.73; having two vaccine cicatrices, 4.70; having three vaccine cicatrices, 1.95; having four or more vaccine cicatrices, 0.55; having well-marked cicatrices, 2.52; having badly-marked cicatrices, 8.82. 4. Having previously had small pox, 19.He thought those facts—and the examinations throughout Europe, very carefully conducted, had been attended by similar results—would establish, not only the immense security which vaccination afforded against small pox, but that, if rendered complete, the security would be still greater; and, therefore, it was the duty of the House to provide for the full advantages of a thoroughly effective system of vaccination. 1098 He would now state what were the defects of the present law which it was proposed to remedy. During the last few years inquiries embracing the whole of England and Wales had been made by competent medical men, some of whom were well known in the profession, and had published works on the subject—Drs. Seaton, Stevens, Buchanan, and Sanderson—and their reports had been published with the annual Report of the Medical Officer of the Privy Council. The statements which satisfied the Government that some further legislation was necessary were that 13 per cent of the children at public infant schools were still unvaccinated, and that of 3,350 deaths from small pox which occur annually in England, 56 per cent were those of children under five years, and 70 per cent those of children under ten. In the course of the inquiries, the arms of nearly 500,000 vaccinated children were examined; of these, one in eight had been perfectly vaccinated; not more than one in three could be considered as well protected; and in more than one case out of four the vaccination had been of a very inferior kind indeed. The main causes of imperfect and inefficient vaccination were ascertained to have been the frequency with which practitioners, instead of attempting fully to infect the system, had been satisfied with insertions of lymph sufficient to produce only one, two, or three ordinary vesicles, instead of four, the number which constitute perfect vaccination; the want of due attention to the selection of the lymph used in vaccinating; want of care in the performance of the operation, and the great and unnecessary extent to which the use of preserved and conveyed lymph was substituted for arm to arm vaccination. Two of the gentlemen named—Dr. Seaton and Dr. Buchanan—were authorized to inquire into the terrible outbreak of small pox which occurred in London in 1863, fatal to upwards of 2,000 persons. Observations made on upwards of 50,000 children in various national and parochial schools, workhouses, &c, showed that some of the children had never been vaccinated, that the large majority had been vaccinated in various manners and degrees, that of every 1,000 children without any mark of vaccination 360 had scars of small pox, while of every 1,000 who had evidence of vaccination only 1.78 had any such traces. Owing to these reports, very careful inquiries were made into the manner in which the Act had been carried out 1099 throughout the country, and the result had been the discovery of several defects in the working of the law. The principal defects arose from the improper arrangement of districts for vaccination, and from the way in which public vaccinators neglected to fulfil their contracts. Under the Act of 1853, the duties of the Boards of Guardians as to vaccination were as follow:—To divide the unions where necessary into vaccination districts; to contract with a legally qualified medical practitioner or practitioners for the vaccination of each district; to appoint such stations and fix such times for their attendance in the different districts as may enable the contractors efficiently to perform their duties and afford the greatest facilities to the public for obtaining vaccination, and in the words of the 16 & 17 Vict. c. 100, s.1—To take the most effectual means for giving from time to time to all persona resident within such district due notice of the days and hours at which the medical officer or practitioner contracted with for such purpose will attend at such place to vaccinate.The strict duties of the contractors in regard to vaccination were to attend at the station at the times specified by contracts, there and then to vaccinate those who come and to inspect the results on the eighth day; to register the vaccination and the result of the inspection, to give a certificate, if successful, to the parent or person in charge of the child, and to send a duplicate to the registrar of the sub-district in which the operation was performed. Under certain regulations, these duties might be performed by deputies. The Reports of the inspectors had shown that almost universally the subdivision of public vaccination was pushed to such an extent that the objects of the Act were defeated. They had shown that, as a rule, the attendances contracted for were such as would make habitual good arm to arm vaccination rare or impossible that often they were several times as numerous as the births in the same district, so that, even if every born child came to the public vaccination station, there would have been many fruitless attendances for each one vaccination performed. They had shown the division of districts to be such that the number of infants requiring to be vaccinated within one contractor's province was scarcely ever more than enough—very often far less than enough—to maintain first-rate continuous vaccination at even a single station, with a single weekly attendance. Notwithstand- 1100 ing that, the contract subdivided that amount of vaccination among several stations, and often bound the contractor to give at each station an amount of attendance which he must at once discover to be fruitless. That, under these circumstances, the contractor soon came to disregard a contract which he could not carry into effect, and the vaccination of his district was then carried on under no other law than his individual notions of fitness or personal convenience. Details to this effect abound in each inspector's Report, and the general result might be very briefly stated. Among 694 vaccination districts, with regard to which this matter was inquired into, only sixty-four were found where the contractor professed to follow regularly the plan of public vaccination prescribed by his contract. In at least 458 of the districts the places of public vaccination prescribed by contract were confessedly quite disregarded. In 252 of the districts the local registrar of births, in serving upon parents the statutory notice to have children vaccinated, either did not notify any fixed appointments for public vaccination or notified different appointments from those which the guardians had contracted for. These statements he (Mr. Bruce) quoted from the fourth Report of the Medical Officer of the Privy Council. They showed that even if the system had been properly devised, its requirements had been grossly neglected. He was bound to say that the guardians were not exclusively in fault, but that something was due to the erroneous advice given by the central authorities, themselves ignorant of the manner in which the system could be effectually carried out. In 1840, when public vaccinators were appointed for gratuitous vaccination, the advice given was that the districts should be small, it being conceived that the vaccinator would therefore be more easily accessible to the people. But it was found by experience that it was absolutely necessary that there should he a proper correspondence between the number of children who were presented for the first time and the number who had been previously vaccinated; that good vaccination was only possible upon a great scale; and that where it was from arm to arm, unless the lymph were taken from a child within a certain period, it became weak and inefficacious, and the child vaccinated therewith did not derive all the benefit otherwise obtainable. The principal object of the Bill was to give the Poor Law Board 1101 power to re-arrange the districts as often as they should think proper, and also to revise the contracts, so as to remedy the defects stated. Another object was to secure more complete registration. That was only a means to an end, but it was a great one, and important results might follow the adoption of a complete system. It was proposed to increase the pay of registrars from 3d. to 4d.: 1d. to be paid on entry, and 3d., as now, on the completion of the vaccination. At present the certificate of vaccination was sent to the registrar, not of the district in which the birth took place, but of that in which the vaccination was performed, so that there were no means to show that a child whose birth had been registered had also been vaccinated. The Bill provided that the certificate of vaccination should be sent to the registrar of the birth. Hitherto the medical practitioner, not being a public vaccinator, had been bound to send to the registrar a certificate of vaccination without payment; the Bill proposed to cast the duty of transmitting it upon the parent or guardian. It did not propose to alter much the position of public vaccinators; their rate of payment would remain as before; but they would be obliged to act for fixed districts, instead of having a sort of roving commission over a whole union, They would also have to perform and they would be paid for duty performed at workhouses, which they were not at present. A good deal of dissatisfaction had been expressed with the rate of payment; but, after due consideration, it was not thought necessary to increase the burden imposed upon the ratepayers. Increased facilities were to be given to guardians to enforce the law. At present, before a person could be convicted of disobeying the Act it was necessary to prove service of notice upon the parent or guardian; that necessity—the proof being frequently of considerable difficulty—it was proposed to abolish. When a penalty had been once imposed, however trifling, the guardians hitherto could not prosecute for continued neglect; it was proposed to give them power to take further proceedings. In principle the Bill would make every man responsible for the non-vaccination of his child; and as every child born since 1853 and not vaccinated remained unvaccinated in defiance of the law, there would be no hardship in enforcing the law against all parents who had disregarded it in the case of all children not above thirteen years of age. The proposed 1102 amendments of the law would, he believed, conduce to greater efficiency in vaccination, both as to quantity and quality, without unnecessary interference or undue pressure upon the rates. A number of petitions which had been presented did not go so much against the Bill as against the principle of vaccination. One objection was, that it had been made the means of introducing into the system other diseases than small pox. On this point Dr. Seaton said—Those who have had most to do with the performance of vaccination, on the one hand, and those who have been most concerned in the treatment of infantile disease, on the other, concur in the belief of the non-communicability of disease by vaccination, Mr. Marson, in the performance of 50,000 vaccinations and more, 'has never seen other diseases communicated with the vaccine disease, nor does he believe in the popular reports that they are so communicated.' Such, also, was the experience of the late Mr. Leese, whose opportunities of observation were scarcely, if any, less. Dr. W. Jenner stated some years ago that at University College Hospital and at the Hospital for Sick Children he had had, in six years, more than 13,000 sick adults and children under observation, and that in no case had he reason to believe, or even to suspect, that any constitutional taint had been conveyed from one person to another by vaccination. Dr. West's experience of 26,000 infants and children under his care in seventeen years is to the like effect; in stating that he has seen nothing in that time to make him believe that vaccination excites cutaneous eruptions in any but very exceptional cases, he refers such exceptional eases to a disposition in the children themselves, brought out by the vaccination as it might have been by teething. And Professor Paget, speaking from his large experience among children in the out-patients' room at St. Bartholomew's, and enumerating some of the causes which develop cutaneous diseases in young children, says, 'Now, vaccination may do, though I believe it very rarely does, what these several accidents may do—namely, by disturbing for a time the general health, it may give opportunity for the external manifestation and complete evolution of some constitutional affection, which, but for it, might have remained rather longer latent. This is,' he adds, 'the worst thing that can with any show of reason be charged against vaccination; even this can very seldom be charged with truth.'A statement had been widely circulated that syphilis had been introduced into the system by vaccination. Millions of children had been vaccinated in the last sixty years, but not a single case had occurred in which it had been proved that syphilis had been communicated. A case was alleged to have occurred in France in which a child had been vaccinated from another which inherited syphilis; but the surgeon in that case, in taking lymph from a child covered with syphilitic blotches, acted in monstrous disregard of common prudence, and medi- 1103 cal knowledge. No such case, so far as the most careful medical research could discover, had happened in this country. He did not think it necessary to argue the general question of vaccination. He had read many letters objecting to the compulsory system, but the House and the country were in favour of compulsory vaccination, and the only question was as to the best machinery for enforcing the law.
§ Motion made, and Question proposed, "That Mr. Deputy Speaker do now leave the Chair."
said, he believed that in many parts of the country there was a strong wish and disposition to see the question of vaccination put upon a footing more satisfactory than that it at present occupied. They had listened with interest to the speech just made, but he was afraid it contained many statements which would not pacify people's minds. One remarkable statement was that there had been an examination of 500,000 children belonging to the humbler classes. They were the class who were principally affected by what was called compulsory vaccination. Of the number so examined, only one in eight were found to have been perfectly vaccinated. This fact involved the further fact that seven out of eight were imperfectly vaccinated, or not vaccinated at all. The Bill provided that all children under thirteen not perfectly vaccinated were to be laid hold of and vaccinated again. ["No!"] He might have read the Bill wrongly, but he read it so. If only one in eight had been perfectly vaccinated, great doubt would come upon many people's minds as to what the others might have been vaccinated with—what the virus or lymph might have been that had been put into them. The right hon. Gentleman said that if you catch a child at a particular time the lymph is not good. This Bill contained no provision to obviate what was greatly complained of in the country—namely, the want of security not only that a medical man had necessary skill and experience, but that he obtained the proper lymph, or whatever it was that was necessary for the operation. Under the Bill you might catch a boy twelve years old and compel him to drink, but there was no statutory provision to prevent his being compelled to drink poison. This was the great defect in the Bill.
MR. H. A. BRUCE
said, that under the Act of 1858 (the Public Health Act) 1104 every public vaccinator had to submit to an examination at one of the fifteen examining stations, and, in order to supplement the supply of lymph, the National Vaccine Establishment issued 200,000 charges of good lymph every year.
said, he was aware of these facts; but he must still ask, what became of the matter taken at a certain time from a child's arm? The failure in seven cases out of eight must arise from the arrangements as to districts preventing interchange between one vaccinated and one wanting to be. It was no answer to speak of the quantity of lymph which had been supplied. He might be wrong, but he knew the public impression was that there had been great difficulty in getting good vaccine, and he did not find in the Bill any security for the quality of the vaccine. If vaccination were to be compulsory, the question was, would the Bill improve the manner of doing it? One of the great blots upon the Bill was, that it failed to provide the security he had indicated. He believed that no service was well done unless it were well paid for. That was his firm belief, although the view might be a low one, and he believed that one of the main reasons why vaccination had been less successful than it otherwise might have been was that the public vaccinators had not been sufficiently paid. Time was of value to everybody, and medical men and lawyers thought more of it than others. When a man went three or four miles to a place where a lot of children were gathered together and was only paid a small sum per head, we knew very well that it was in human nature he would be apt to discharge his duties in a perfunctory manner. He believed that if they would pay men to do the work better they would have it better done. The right hon. Gentleman (Mr. Bruce) said they would not, but he believed that if they did not pay better they would not have the work one jot better done. Parents could gather a great deal for themselves on this subject, and their belief as to the way in which the work was done was one reason why many children were not vaccinated. It might be, as the right hon. Gentleman had said, that a certain question was put, and that it was answered in a particular way, but that was because the question was a particular one—namely, whether anything mischievous happened when vaccination was properly performed? Of course there could be but one reply, in the 1105 negative, to that. But the mischief happened when the operation was improperly performed. Of course, it would be done unconsciously; the medical man had to do things in a hurry, and was paid very little. They all knew that when they wanted anything of this kind done the medical man told them a fine cock-and-bull story about waiting until he found a healthy child; and then it was all right and it was done. That implied that all persons ran some risk, and, although it might be said there had been no ca3e for sixty years in which disease had been communicated, they would not make him believe that medical men would take all these pains in cases where they were well paid, if there were not some grounds for doing so. They might not, perhaps, believe that any particular form of disease would be manifested, but complaints were made in his own county and neighbourhood that after vaccination children had been affected with some rash, or something or other. They could not all have had that in their constitution. When all the children were in the same boat, the fact carried a conviction which all the medical men in the world could not remove. As the right hon. Gentleman opposite (Mr. Bruce) properly said, it was an abomination for any medical man to take the vaccine matter from a child otherwise diseased. Undoubtedly it was, but it was possible that a medical man might not know that the child from whom he took the matter was diseased; and that was the more likely to be the case when no particular notice respecting the examination of the child had been given to him. If a medical man asked the parents questions as to whether their children were suffering under disease, he would very likely incur the risk of receiving a slap in the face from the mother for his trouble in the matter. The clause requiring parents whose children had not been vaccinated by the public vaccinators to send in certificates of that fact was, he thought, rather complex and hard. He hoped that when they dealt with the clauses of the Bill that would be considered, and that provisions would be introduced for securing proper lymph and adequate payment for the work to be done. Another point he would mention was that the Bill in its present state would bring things to a dead lock if a Board of Guardians and the Poor Law Board happened to be awkward together.
§ SIR ROBERT PEEL
said, he saw many defects in the Bill, which would require 1106 careful consideration in Committee in order to render it advantageous to the country. He agreed with the right hon. Gentleman opposite (Mr. Henley) that the remuneration proposed to be given to the persons who were to carry out the provisions of the Bill was not adequate for the duties to be performed. There were, however, far more important objections to the Bill, which was most loosely drawn up, and which in its then shape would never be a satisfactory measure. The right hon. Gentleman (Mr. Bruce) in introducing the Bill made a very interesting and able speech, in which he went through the history of the laws relating to vaccination which had been passed since 1802 down to the present time, and which were to be repealed by the present Bill. The right hon. Gentleman called the Bill a Consolidation Bill, whereas its very first clause proposed to repeal the major part of the six Vaccination Laws which had been passed during the reign of Her Majesty. He had told them that the present system was not satisfactory, and that four medical officers had been visiting different parts of the country during the last four years for the purpose of obtaining information upon this subject. The right hon. Gentleman had read a condensation of the Reports of those medical officers, which had been sent to the Privy Council and had been published, and which showed the existence of a most alarming state of things. It appeared from the Poor Law Reports of 1862 that of the 702,181 children born in that year only 437,693 were successfully vaccinated.
§ SIR ROBERT PEEL
said, that the words of the Report were that only 437,693 children were successfully vaccinated. The right hon. Gentleman said that the great object of the Bill was to obtain good vaccine matter for vaccination, but the Bill did not mention when the matter was to be taken. The right hon. Gentleman opposite (Mr. Henley) had with justice laid great stress upon that point, as the medical officer of the Privy Council had stated that the vaccine matter, if not taken from the child on a particular day, became pernicious, and instead of doing good rather tended to create disease. [Mr. H. A. BRUCE: No!] The right hon. Gentleman said "No!" but the medical officers in their Report to the Privy Council stated that to be the fact; 1107 and, moreover, it was well known that country practitioners were compelled to take the matter from the arm on a particular day, or otherwise it became useless, if not pernicious. Another object of the Bill was stated to he the enforcement of the performance of the duties of the contractors and the medical practitioners, which were at present often neglected, and, in fact, its intention was to give the country a complete system of vaccination, which the Act of 1853 had failed to do. No doubt, if these objects could be attained, the Bill would be most beneficial to the country, but he wished to ask the right hon. Gentleman, who would be responsible for the proper working of the Bill? No doubt in one of its last clauses it contained what he might almost call the offensive regulation that the registrars, who were to be so badly paid—they would only receive 3d. or 4d. for each child vaccinated—were to fulfil the duties of informers as to the children in their districts who were not vaccinated. This was very hard upon men who received such inadequate remuneration for their services. Again, in another clause at the end of the Bill, magistrates were required to send for their neighbours' children, and to examine their arms, in order to ascertain from the marks whether they had been properly vaccinated. This was a pleasant office to be imposed upon country gentlemen. He doubted whether any but the stipendiary magistrates would perform it. He could only express his surprise that the right hon. Gentleman, with his knowledge of these subjects, should have permitted such a clause to be introduced into the Bill. Beyond those clauses the Bill contained nothing to show who was to be responsible for its proper working. Of the thirty-three clauses of the Bill, at least ten or twelve could never pass through Committee, or if at a late hour some evening they should pass, the whole Bill would be rendered inoperative if not prejudicial. He would, for instance, compare Clause 9 with Clause 26. Clause 9 enacted—No payment in respect of vaccination shall be made out of the common fund of any union, or out of the poor rate of any parish, or out of any other public or parochial fund, where the Poor Law Board shall not have approved of a contract for the performance thereof, or after they shall have determined any such contract; and every payment made contrary hereto shall be disallowed by the auditor in the accounts of every Board of Guardians, or of the overseers, or of any officer who shall have made the same.1108 On the other hand, Clause 26 was to the following effect:—The guardians of any union or parish may pay out of their funds all reasonable expenses incurred by them in causing notices to be printed and circulated as to the provisions of this Act, and in and about inquiries and reports as to the state of small pox or vaccination in their union or parish, and in taking measures to prevent the spread of small pox and to promote vaccination upon any actual or expected outbreak of that disease therein, and may compensate any officer appointed by them to prosecute persons charged with offences against this Act, or otherwise to enforce its provisions.Thus Clause 26 gave a power to the Boards of Guardians the exercise of which Clause 9 expressly forbade, except in cases where contracts had been made. Again, by Clause 14—The registrar of births shall, on or within seven days after the registration with him of the birth of any child not already vaccinated, give a notice, according to the form in the Schedule hereto annexed marked A, or to the like effect, to the parent, or in the event of the death, illness, absence, or inability of the parent to the person having the custody of such child, if known to him, requiring such child to be duly vaccinated according to the provisions of this Act, and specifying the days, hours, and places where the public vaccinator of the vaccination district wherein such child resides, or the vaccinator of any station duly authorized by the Lords of Her Majesty's Council, will attend for the purpose of performing the operation, and such notice shall be accompanied with forms according to those in the said Schedule marked B, C, and D.He held a letter in his hand pointing out the difficulty of carrying those clauses into effect. Surely it would be much better if the forms B, C, and D, were to be given to the medical officer and not to the parent or person having the custody of the child, by whom they would be sure to be mislaid. Clause 23 referred to the question raised by the right hon. Gentleman opposite (Mr. Henley)—namely, as to the amount of remuneration which persons were to receive for working the machinery of the Bill. He trusted that the House would, in its wisdom, on a matter of such grave importance—where it was impossible to overestimate the misery which would result from improper vaccination—direct that the persons carrying out the provisions of the Bill should be sufficiently remunerated for their labours. He understood that before Easter a deputation waited upon the right hon. Gentleman who had introduced the Bill to bring the subject of the remuneration of registrars and medical practitioners particularly under his notice, and that the right hon. Gentleman had led those gentle- 1109 men to believe that he was prepared to deal with the matter in a liberal spirit. Looking at the Bill, however, he should suppose that the right hon. Gentleman had altered his mind upon the point. He also saw that the Bill directed that the parent of every child should take it to the public vaccinator, to be vaccinated within three months of its birth. In 1863, when he was the Chief Secretary for Ireland, he had introduced a Bill for the purpose of enforcing compulsory vaccination in Ireland. In that Bill be extended the time for compulsory vaccination to six months, which, in his opinion, was quite early enough for the purpose, and it had worked well. But this Bill enacted that the children should be taken to be vaccinated at the age of throe months, so that a child born in the month of October would have to be carried in the depth of winter to the medical officer, who, in many parishes, lived several miles distant. The Bill further made it imperative that the child should be brought before the vaccinator on the seventh day after the vaccination. In Ireland it was eight days, and medical men were generally of opinion that the eighth or ninth days were the best. He did not make these objections to the Bill with the view of obstructing the passing of such a measure, but with the intention of putting it to the House, whether there was not in this Bill matter which required very careful consideration, and whether it would not be better to postpone the Committee upon the Bill until the right hon. Gentleman had had time to re consider its provisions. What was required was a Bill which would give the country a complete system of vaccination, which he was afraid the present Bill would not do.
§ MR. HARVEY LEWIS
said, he regretted that the Bill had been so carelessly drawn up that it was impossible to shape it properly, either during the discussion that was then going on, or in Committee. One grave defect in the Bill was that it did not provide for the purity of the lymph to be used, as, if it were clearly understood that none but healthy lymph would be used, the chief objection of the lower classes to vaccination would be removed, The subject of vaccination was one of such vast importance that it demanded the fullest deliberation and inquiry before any steps were taken in the matter, and under these circumstances he did not hesitate to say that the subject should be postponed until a Bill could be drawn up, founded upon the recommendations of a Select Committee. 1110 He felt this so strongly that he could not in justice to himself, and to the millions affected by this legislation, do less than move that the Bill be now referred to a Select Committee.
§ SIR JERVOISE JERVOISE
said, that he seconded the Motion. He wished to advert to the dangers likely to arise from the use of unhealthy lymph. If the lymph were not removed within a certain time, it fermented and became putrid, and then, in the words of an eminent medical gentleman, it became as dangerous as the cut of a dissecting knife. He hoped the right hon. Gentleman would permit this matter to go to a Select Committee. It was a question of science, and could only be advantageously considered in Select Committee.
§ Amendment proposed, to leave out from the word "That" to the end of the Question, in order to add the words "the Bill be committed to a Select Committee,"—(Mr. Harvey Lewis,)—instead thereof.
said, he believed that the course recommended by the hon. Member for Marylebone to refer the question to a Select Committee was the best that could be adopted, as there were many points in the Bill which required full and careful consideration. He hoped the right hon. Gentleman would consent to the proposition. The town which he represented had suffered much from this disease, and a number of suggestions had been made to him. There was a general opinion that the law at present was a dead letter.
§ MR. HIBBERT
said, he saw no objection to the question going before a Select Committee, provided no evidence was to be taken on the subject, which would throw the matter over this Session. Everything in connection with vaccination was well known, and if evidence were taken before the Select Committee, the only effect would be to give every person an opportunity of coming forward to ventilate his crotchets upon the question. The machinery of the existing system was far too complicated, a great deal of trouble being thrown upon the local authorities, in addition to the cost of £16,000 per annum. It would be an improvement of the system were the Privy Council to take the whole responsibility and management. Although the remuneration of medical practitioners might be ample in large towns, yet in country districts, where but few children were vaccinated at one time, he did not think the 1111 amount proposed to be allowed them was sufficient. He disapproved the clause relating to re-vaccination, as he believed that under it any grown-up person might be compelled to be re-vaccinated against his will.
§ MR. BARROW
said, he did not agree with the hon. Gentleman who had just sat down, that no evidence should be taken before the Select Committee, as "crotchets," as he called them, of medical men on this subject deserved careful consideration. He confessed that from all he heard from medical men, both English and foreign, he doubted the efficacy of the present system of vaccination, and therefore trusted that full inquiries would be made before a system of compulsory vaccination was forced upon the country.
§ MR. AYRTON
said, that he had been intrusted with a great many petitions against this Bill. He could not help being struck by the admission of the right hon. Gentleman in introducing this Bill, that the present system had entirely failed in effecting its object. The Bill before them, besides being inaccurately drawn up, bore too much of the stamp of the official departments in which it had been prepared. Those departments had given great powers to themselves, but had not taken sufficient care to guard the public from the dangers likely to arise from the working of the Bill. He hoped that care would be taken, if compulsory vaccination were enforced by penalties, that public vaccinators should also be liable to penalties in case the vaccination were not done properly. As there were a great many people who believed that vaccination did just as much harm as good, he trusted that the inquiry of the Committee upstairs would not in any way be fettered. If they agreed to send the Bill to a Committee upstairs, that Committee could soon see whether they would be able to dispose of the Bill without further information. The best way was to leave it to the Committee to decide whether they should take evidence or not, and if it were necessary, a Motion could be made to allow them to take evidence.
§ COLONEL NORTH
said, he believed that the scale of remuneration to the medical officers was in many cases too low. He hoped the Bill would provide that no expense or trouble be spared to procure the proper vaccine, and thus to remove much of the prejudice which existed against vaccination among the lower classes.
§ SIR ROBERT PEEL
said, he trusted that the right hon. Gentleman (Mr. Bruce) 1112 would consent to refer the Bill to a Select Committee, especially as throughout the whole-of the discussion it had not received the support of a single Member. He would also suggest to the right hon. Gentleman whether it would not be better, at the present moment, to withdraw the Bill, which was generally acknowledged to be defective in many of its clauses, and to introduce a fresh measure at no distant date, founded upon the recommendations of the Select Committee to which it was proposed to refer the Bill.
§ MR. BRISCOE
said, he could not agree in the suggestion that the Bill should be withdrawn altogether, but he heartily joined in the request made to the Vice President of the Council that the Bill should be referred to a Select Committee. His constituents thought there should be more inquiry before there was more legislation.
MR. H. A. BRUCE
said, but for his unwillingness to interfere in the discussion, he should have risen long ago to state that he was willing to refer the Bill to a Select Committee. Although he did not wish that the power of taking evidence should be limited—being desirous of making the machinery as perfect as possible—it must be distinctly understood that they did not in any way go into Committee upon the principle of the Bill. As far as legislation could effect that result, the securing of the proper quality of vaccine had already been provided for, the fullest direction having been given to the medical officers on the subject. Any failure that had attended the efforts in this direction had been caused only by the want of power on the part of the central authorities. It was to secure better arrangements being made that this Bill was brought in. With regard to the suggestion which had fallen from the right hon. Baronet the Member for Tamworth that the Bill should be dropped, he would have been quite prepared to show in Committee that the clauses which the right hon. Baronet regarded as defective were in reality not open to that charge. [Sir ROBERT PEEL: Which clauses?] All of them. The clause refering to the seventh day, following the day on which vaccination was performed, in reality left the matter in the same position as it was now, and no medical man in the country would have dreamt of proposing any alteration in this respect. There appeared to be an opinion rife in some quarters that it was intended to take powers by this Bill to re-vaccinate 1113 adults, but that was not the case. The Bill gave power to issue regulations limiting the practice of re-vaccination but not enforcing it. The House seemed to have forgotten, with reference to the payment of public vaccinators, that the scale fixed by the Bill—of 1s. 6d. and 2s. 6d. in different cases—was the minimum payment to be made, and that the boards of guardians were empowered by the measure to fix a just and equitable scale. He fully admitted that in rural districts, where the minimum only was paid, the remuneration would frequently be inadequate. But the guardians had power in those and in all cases to increase the rate of payment, and in populous districts even the minimum secured by the Bill was generally considered sufficient. However, he would be extremely happy to have the assistance of a Select Committee on the Bill.
§ Question, "That the words proposed to be left out stand part of the Question," put, and negatived.
§ Words added.
§ Main Question, as amended, put, and agreed to.
§ Bill committed to a Select Committee.