§ Order for Committee read.
§ LORD ROBERT MONTAGU
said, that although there was no Act passed in favour of vaccination until 1840, Parliament early showed that it favoured vaccination. In 1802 it voted £10,000 to Dr. Jenner, the discoverer of vaccination. In 1807 it voted £20,000 additional. For nearly fifty years it continued by annual grants to support the National Vaccine Establishment. In 1840 an Act was passed giving facilities for vaccination, and putting it within the reach of every person in the country to be vaccinated at the public cost. The guardians of the poor were to administer the Act. To carry it out they contracted with medical men, who thus became public vaccinators; and the expenses were paid out of the rates. 1864 Under a mistaken idea of increasing the facilities for vaccination, the Poor Law Commissioners subdivided the vaccination districts; they increased the number of vaccinators, and the number of stations at which children might be vaccinated. In 1853 a compulsory Act made it obligatory on all parents to get their children vaccinated within four months of birth. The parents were rendered liable to a penalty if they neglected or refused to obey this enactment. The Poor Law Commissioners repeated the mistake they had previously made, by going still further astray in the same direction. They again increased the number of districts, and multiplied the vaccinators and stations. The result was that the medical man, instead of vaccinating at certain stations on stated days, at last vaccinated as he went his rounds every day. Thus arm to arm vaccination was discontinued; for the vaccinator could not get fresh lymph from the arms of the patients which were vaccinated eight days before, but had to carry prepared lymph in his pocket. Prepared lymph lost much of its vitality, and the chances were against its being effectual in vaccination. It was necessary, in order to successful vaccination, that the two classes of patients — those that had been vaccinated eight days before and those that were to be vaccinated—should meet in order that the doctor might take the vaccine from the arm of one and transfer it to that of the other. The 2nd clause of the Public Health Amendment Act of 1858 gave the Privy Council power to issue regulations to secure the due qualifications of doctors and for their guidance in the process of vaccination. The provisions of these three Acts afforded sufficient indication of the intentions of the Legislature. The nation evidently had determined that good and effective vaccination should be brought within the reach of all; that it should be obligatory on parents to take advantage of these facilities; and that there should be a machinery for carrying out and enforcing the law and detecting defaulters. The Legislature had also pronounced its intention that the fulfilment of the law was to be ascertained by a system of registration and certificates; that the guardians were to cause proceedings to be taken against defaulters; and that penalties were to be recoverable at law. The Act of 1853 had failed, however, to a certain extent. Vaccination had not been so general as it ought to 1865 have been. It had been ascertained that in elementary and workhouse schools, from 20 to 30 per cent of the children were not vaccinated. In some cases as many as from 40 to 50 per cent had not been vaccinated. At Penn, in Buckinghamshire, the percentage of unvaccinated children was 55½ per cent. In 1862, 150 districts were visited by Dr. Sanderson, and in only 108 were any contracts with vaccinators in existence, and in only thirty-eight of these were the contracts fulfilled by the medical men. Out of fifteen unions the vaccination arrangements advertised. In one case the doctor had contracted to give habitual attendance, at identical times, in three different parishes. As to the quality of the vaccinations; of 127 districts visited by Dr. Sanderson there were twenty-one in which the bad vaccinations were from 30 to 62 per cent. In only thirty districts were 50 per cent of the children really protected from small pox. The existence of defects both as to quality and quantity were proved by the numbers of deaths from small pox relatively to the population. The average of deaths in England and Wales from small pox was now 3,967 per annum, yet in 1863 the actual number was 5,964; in 1864, 7,684; in 1865, 6,411; making a total in three years of 20,059, while in each of these years the number of deaths was far above the average. In 1866 the number of deaths in London alone was 1,389. And in the first quarter of 1867 the deaths amounted to 526 or 2,104 deaths from small pox per annum in London alone. These figures therefore furnished a sufficient argument in favour of further legislation, and it was strengthened by the experience of compulsory vaccination in Scotland. In that country before the Act passed the deaths from small pox were 2,000 per annum. The Act was passed in the autumn of 1863. In 1865 there were 123 deaths; in 1866 there were 280. There were places in England where the Vaccination Act had not been carried out. With a population in these places of 664,161, there were in those places 1,419 deaths out of the 6,411 small pox deaths recorded in England and Wales in 1865. This was a death-rate of 2,136 per 1,000,000. The inspectors had laid their finger on every one of these places beforehand. They said that the arrangements were bad; that the contracts were not fulfilled; that the certificates had not been 1866 sent in, and that in these places the death-rate from small pox would be great; and in every case the inspectors were right. He would mention a few. There were 73 deaths in Dover, with a population of 31,575; 55 in Canterbury, with a population of 16,643; 70 in Brighton, with a population of 77,693; 151 in Northampton, with a population of 41,152; 106 in Bath, out of a population of 68,336; 59 in Shrewsbury, out of a population of 25,784; 72 in Burton-on-Trent, out of a population of 41,065; 126 in Whitehaven, out of a population of 39,950; 104 in Newport—Monmouth, out of a population of 51,412; 92 in Pontypool, out of a population of 30,288; 82 in Cardiff, out of a population of 58,285; 91 in Pontypridd, out of a population of 30,387; 185 in Merthyr Tydvil, with a population of 93,000, and 153 in Neath out of a population of 58,583. The inspectors were was that cause which it was the object of this Bill to remove. Why, then, was the Act not carried out? The Act was not carried out because the machinery was imperfect—the check was not sufficient. Boards of Guardians were lax until there was a panic, and then there was a rush to the public vaccinators, and many were re-vaccinated who did not require it. The coercive provisions of the law were feeble, ambiguous, and not stringent enough; and in many cases the traditions of the justices were substituted for the commands of the Legislature. It was the desire of the Government to improve this state of things. That was the task which the Legislature was now called upon to perform. What were the materials which were ready to hand? The facilities of 1840, the compulsion of 1853, and the machinery of check of 1853. The compulsion enforced by the Act of 1853 was repeated in this Consolidation Bill. Every child before attaining the age of three months was to be vaccinated, either by a public or private vaccinator. After eight days the child was to be brought for inspection, and either be vaccinated again, or have the lymph taken from its arm for the vaccination of others. The principle was affirmed in 1853. After ten years' experience it was applied in compulsory Acts for Scotland and Ireland. It was now sought to assimilate the law of England to that of Scotland and Ireland. A similar Bill was introduced last year by the right hon. Gentleman (Mr. Bruce). 1867 It went before a Select Committee, and was sifted carefully, clause by clause. The Bill now before the House was in almost the words in which it had come down from the Select Committee. He would now lay before the House statistics showing some of the results of vaccination. The average annual death-rates from small pox during thirty years previous to the use of vaccination amounted to 3,000 in every 1,000,000 of the population. From 1838 to 1841, when vaccination was known and encouraged, but when there was no public provision for it, the deaths fell from 3,000 to 770. From 1841 to 1853, when there was gratuitous but not compulsory vaccination, the average number of deaths fell to 304 in every 1,000,000. Since vaccination had been rendered compulsory up to 1865, the average death-rate was 171, or, including the last two years, 202 in every 1,000,000 of the population. Before 1853, taking an average of five years, the number of vaccinations in England and Wales was 180,960. In 1854, when vaccination was made compulsory, the number was 408,824. As the number of vaccinations increased the number of deaths decreased. That was the case as regarded England. In Scotland compulsory vaccination was completely carried out; the time allowed for vaccination, however, being six instead of three months as in England; this was a disadvantage to Scotland, which the Scotch now desired to remedy. The result, however, was remarkable. In 1864 the number of children born, and for which notices of vaccination were given, was 108,851. Of these there died during the six months allowed before vaccination 9,180; 96,970 were vaccinated and registered. Children unaccounted for, and of whom no entries were made in the registers, 2,701. Not quite 2 per cent! In 1865 the results were still more satisfactory. The number of children born was 113,129; of these 9,366 died before vaccination. 101,082 were vaccinated and registered; leaving 2,681, less than 2 per cent, unaccounted for. In these two years 221,980 notices were given for children born. Only 5,382 were not certified as having been vaccinated. A considerable portion of these were of course illegitimate children and children untraceable, owing to wrong names of the parents having been given. In 1863, the date of the Act which made vaccination compulsory in Scotland, 1,646 deaths occurred from small pox. In 1865 the 1868 number of deaths was 123, so that with a complete system of registration and certificate the number of deaths was there reduced to a minimum. In England, in some districts, the energy of the public vaccinators and of the local authorities had supplied the defects in the Act of 1853 and made it a perfect Vaccination Act. In Mold, which was in the district of Holywell Union, with a population of 16,000, Dr. Hughes had been very energetic. Every one of the children had been vaccinated. Epidemics of small pox had raged in surrounding districts, and small pox had even been imported into Mold. Yet since 1853 only one child had succumbed to it. This was a baby a few days old, whose mother, a stranger to the town, had "modified small pox" when the child was born. From a Return moved for by the right hon. Gentleman (Mr. Lowe), showing the number of deaths in the 627 registration districts during the years 1851–60, it appeared that in 44 of those districts the deaths from small pox had been absolutely nil, because the guardians and vaccinators had been active and had supplied the deficiencies of the Act. In 297 other districts the annual death-rates by small pox per 100,000 children under five years of age were from 1 to 50; in 131 other districts the death-rates were from 51 to 100. In 75 districts the death-rate was from 100 to 150; in 39, from 150 to 200; in 24, from 200 to 250; in 8, from 250 to 300; in 5 from 300 to 350. In Shrewsbury district the annual death-rate was 382; in Northampton 456; in Plymouth 463; and in Merthyr Tydvil district 572. These statistics showed that in proportion as compulsory vaccination was carried out the deaths diminished. Where it was not so carried out the ravages of small pox increased. It might be said that vaccination was not always effectual. No doubt that was so. It arose from two causes. First, doctors of experience said that this failure was mainly owing to the use of preserved lymph. If the virus was taken fresh and the vaccination was from arm to arm, the operation would generally succeed, but where lymph was carried about in glass tubes there were sure to be numerous failures. It was necessary therefore that the two classes of patients should meet, and that they should be in sufficient numbers to enable the vaccinator to make a selection. The vaccination districts should therefore not be small. In thinly-populated districts poor persons might have 1869 to travel far in order to meet the requirements of the Bill. These cases were rare, and there was a clause which expressly provided for them. The great majority of cases would occur in large towns and thickly populated districts. Large towns were foci of disease or else centres of good lymph. Secondly, the vaccinators must be experts, if the vaccination was always to be effectual. If the Government said to the poor that their children must be vaccinated, they said in effect that the poor must take their children to Dr. Smith or Dr. Brown. Therefore it was the duty of the Government to see that these doctors were duly qualified for their work. With that view, they had first the Privy Council regulations of 1859; secondly they had four Inspectors, whose duty it was to travel once in two years round the districts allotted to them. Until now their only duty was to give advice and to report. In future gratuities were to be given to those public vaccinators who vaccinated successfully. Last year Parliament voted a sum for the purpose of these gratuities, which were distributed by the Privy Council. The system worked well, and the present Bill contained a clause, proposed by the right hon. Gentleman (Mr. Lowe), making the system of paying for results a permanent one. When the Inspector reported that certain vaccinations were of the first-class, the doctor would receive 1s. over and above the sum paid by the guardians for each vaccination which he had performed, if the vaccinations were reported as of the second-class, he would receive 8d. For the third-class vaccinations nothing further would be paid. The ratio of children born to the population was about 3½ per cent, which would give 700,000 a year for a population of 20,000,000. Reckoning that four-fifths of these children, or 560,000, would be vaccinated gratuitously during the year, the expenditure would be £28,000 if these vaccinations were all reported of the first-class, and £18,500 if of the second-class. Was it, then, too much that a sum between £18,500 and £25,000 a year should be expended in order to save 7,000 lives and make it certain that there should never occur a case of small pox? So much with regard to compulsory vaccination. A few words as to the checks. The registrar, on the birth of the child being registered, was bound to give notice to the parent, and to supply the proper forms. He was to enter in a book the 1870 name of the child and the other means of identification. The public vaccinator was after vaccinating to send the certificate of successful vaccination to the registrar. The registrar was to enter it in his book. By that means the registrar could tell what children had been vaccinated in his district and what not, what children were liable to small pox and what children not liable. Then it was made the interest of all the parties concerned to carry out the system and to see that the checks were enforced. It was the interest of every local registrar to hunt up every birth, because for every birth he entered he had a payment of 1s. It was his interest to obtain the certificate of successful vaccination, because for entering each certificate he would obtain 3d. It was the interest of the doctor to vaccinate every child, or to forward the certificate of successful vaccination to the registrar, because he had at least 1s. 6d. for each successful operation — in some cases as much as 2s. 6d. It was the interest of the parent to take the child to be vaccinated, or he would run the risk of legal proceedings, and be liable to a penalty of £1. Small pox differed from other epidemics in this, that it was one of the worst, but was absolutely preventible. In other diseases, all that could be done by the removal of predisposing conditions was to mitigate their virulence. By purifying water, removing filth, or strengthening the human system, it was possible to weaken the power of other diseases; but small pox might be altogether prevented. If, then, one who raised his hand against another and killed him was guilty of murder, of what would he be guilty who by voice or vote in that House endeavoured to prevent the passing of a measure which would make it absolutely certain that small pox should not kill 7,000 in the year? That was the case he had to place before the House, and he felt confident the House would know how to deal with it. He moved that the House do go into Committee on the Bill.
§ Motion made, and Question proposed, "That Mr. Speaker do now leave the Chair."—(Lord Robert Montagu.)
§ MR. BARROW
said, that it was nearly seventy years since Dr. Jenner had introduced vaccination. It was the opinion of many medical men now that vaccination had produced disease to a dangerous extent. He had received communications from a great number of persons, not only 1871 in England, but on the Continent, thanking him for the protests he had felt it his duty to make against the system of vaccination. He had also received communications from the friends of the system, entreating him to persevere in his opposition to the compulsory clauses of this Bill, on the ground that it interfered with their hopes of extending vaccination. They felt that in a free country like this an attempt at compulsion would be the means of defeating the object in view. He would not enter into the mode by which the noble Lord proposed to carry out this system, because he objected to vaccination altogether. But he thought it would be impossible to carry it out. His objections were founded upon statements made by a number of parents, some of them medical men, whose children had died or suffered great injuries to their constitutions from vaccination. Those medical men, who had had every opportunity of observing the effects of vaccination, were surely not to be compelled to introduce this poison which they deprecated into the bodies of their children? In the Continental papers there were reports of injurious effects produced by this system. The Emperor of the French had discontinued vaccination in his army in consequence of the medical reports of the injury produced by it, and the diseases to which the practice had given rise. Until there was a full investigation of the consequences of vaccination they would never remove the prejudices which existed against it, or obtain that extension of the system which was said to be effectual for the prevention of small pox. Was the House to impose upon parents the necessity of having their children vaccinated every seven years? He hoped the House would not proceed any further with the Bill. He therefore moved that it be committed that day three months. It was a fact in proof of the view which he took that the deaths from small pox had increased in this country since the introduction of compulsory vaccination. Small pox had been very frequent in London lately. Out of the number of persons infected who had been taken to the Small pox Hospital, from 75 to 78 per cent had been previously vaccinated. There were only from 22 to 25 per cent who had not been vaccinated. He hoped this Bill would not be passed until some complete and thorough investigation had been made into the whole matter.
§ SIR J. CLARKE JERVOISE
said, he had been astonished to hear from the noble 1872 Lord that small pox could be exterminated. There were many cases of persons being attacked by it after having been vaccinated. He knew of such instances with regard to persons who were vaccinated by Dr. Jenner. The same chymical influences which turned even London cream sour — and there was a story of a Cockney who on visiting the country was surprised to see the thick part of the cream at the top of the jug, since he had always known it at the bottom — affected the lymph on a child's arm. When inserted in another child's arm it was sometimes nothing but putrid matter. Yet this Bill would oblige every infant to undergo this risk, no matter at what period of the year. He had known cases where such decomposition had occurred. The noble Lord also said that Dr. Jenner had a grant of £10,000 in 1802 for the introduction of vaccination; but Dr. Jenner never received the money, though he had to pay 5 per cent income tax upon it. There were some subjects—such as theology—which were generally regarded as beyond the ken of the House. He thought etiology ought to come within the same category. If even with a revelation people could not agree on theological matters, how could it be expected that they should agree to a rigorous enactment on a subject like this, on which doctors notoriously differed? The House before being called on to pass such a Bill ought to have the Report of the Medical Officer of the Privy Council for 1866. This document, notwithstanding his remonstrances on a previous occasion against the late period of the Session at which it was usually produced, had not yet been laid on the table. That Report might contain information of the greatest value and importance. It was impossible that medical science could have stood still upon such a subject as this. He held in his hand the third Report of the Cattle Plague Commission, which contained a number of coloured plates. In one of those plates was a representation of the hand of a gentleman (Mr. Hancock) who was wounded while dissecting a beast attacked by the cattle plague. The frightful disorder which it was proposed to insert by compulsory vaccination into the body of every child was neither more nor less than cattle plague. It was like that which entered the hand of Mr. Hancock, for it was shown that that gentleman's hand was affected with vaccine matter. They had a claim on the authorities for further information before they 1873 proceeded with this Bill. He would therefore move that the consideration of the Bill be postponed till after the Report had been distributed.
To leave out from the word "That" to the end of the Question, in order to add the words "the Committee be postponed till after the Report of the Medical Officer of the Privy Council, 1866, shall have been distributed,"—(Sir J. Clarke Jervoise,)
§ COLONEL BARTTELOT
said, he hoped that the Amendment would be pressed to a division. No evidence was taken by the Select Committee last Session. This ought to have been done on so important a subject. The people were willing to submit to much that Parliament might impose on them. But if their opinions were combated they expected to be shown by practical experience that they were wrong, and that Parliament was right in enforcing what many of them believed to be prejudicial to health. Whether vaccination was a good thing or not he would not say; but before passing a measure like this the House ought to be furnished with every information on the subject. There were 750,000 parents, who surely deserved some consideration. Of these 750,000 persons there were 250,000 who could not read or write; yet they were liable to a fine of 20s. if they did not follow the forms supplied under the Act. It would be very difficult to have these forms transmitted in agricultural districts. The noble Lord would have made a very different speech on this subject if he had been sitting in his former seat below the gangway. When a man got into office his opinions varied, his predilections changed, and he assumed a tone which he had never assumed before. The Bill would inflict a hardship, not only on parents but also upon doctors and registrars, the latter of whom would have to perform onerous duties, for which they were badly remunerated. Registration ought not to take place in successful cases. The doctors ought to know exactly what they had to do. It would be much better to send them to the houses of the parents than to make the children come to a certain place to the medical practitioner. Vaccination would not be carried to a successful issue until it was proved to be a wise and right course. He trusted the Bill would be postponed until there had been further inquiry into the whole subject.
said, he hoped it would not be necessary in the year 1867 to discuss the question whether vaccination was a good thing or not. It was said that the Annual Report of the Medical Officer of the Privy Council had not yet been published, but every year a complete Report had been made on this subject, not only by the inspectors, but also in the shape of a resumé of the whole reports made to the Medical Officer of the Council. There had been no new legislation or discoveries since last year. Every possible objection to vaccination had been already brought forward, and to postpone this Bill until the publication of the Annual Report would be to put it off to a period of the Session when it could not be properly considered. The hon. Member (Mr. Barrow) said that on the whole vaccination was a good thing.
§ MR. BARROW
said, that he had received communications from medical men in favour of vaccination. But he had also received letters from others asserting that it had brought injury into their families. He agreed with the latter, and thought that there ought to be no legislation until there had been further inquiry.
said, that compulsory vaccination had been the law of the land since 1852. The present Bill laid down no new principle. It merely collected all the scattered provisions of the law, and supplied the new machinery which had been found necessary by experience. It was a mistake to suppose there had been no inquiry. At the instance of Lord Llanover, Mr. Simon addressed 600 inquiries to the most eminent and experienced medical men in England and other countries. With two exceptions, the replies bore the most unhesitating testimony to the beneficial effects of vaccination. Both before and since that time there had been repeated inquiries by individuals and bodies the most competent to conduct them, and the result had been to show the good effects of vaccination. [Mr. BARROW; What body?] By the College of Physicians and the most eminent men in this country. That very day he had laid upon the table a petition signed by Dr. Jenner on behalf of the Epidemiological Society. The petitioners stated that, though gratuitous vaccination had done great good, and though compulsory vaccination had still further diminished the mortality arising from small pox, the number of deaths in this country was still far greater than it ought to be. Under gratuitous vaccination 1875 the deaths were 304 to 1,000,000 of the population, while since compulsory vaccination had been the law of the land the deaths from small pox were 200 to 1,000,000. They added that, by reason of the defects in the law to which they referred, legislation had not accomplished all the objects of which it was capable, and that the deaths from small pox in England were still very numerous when they were contrasted with the proportion in other parts of Europe—a state of things peculiarly disgraceful to the native country of Jenner. The average number of deaths in England was 4,000. In the three years 1863–4–5, 20,000 persons perished from this malady. The petitioners, therefore, prayed the House to pass the present Bill. The hon. Member (Mr. Barrow) seemed to be under the belief that a patient's chance of recovery was greater if he had never been vaccinated.
§ MR. BARROW
said, he had heard that 75 per cent of the deaths in the Small pox Hospital were of persons who had been vaccinated, and only 25 of those who had not.
said, he wished that, instead of listening to loose talk of this kind, the hon. Member had read the tables compiled by Mr. Marson, of the Small pox Hospital, who had had twenty years' experience. Mr. Marson estimated the chances of death as one in three of those who had not been vaccinated. But where small pox attacked those who had been perfectly vaccinated the deaths were only one in 200, with every variation between the two figures as vaccination had been well or ill performed. It had been said that vaccination imparted disease and injury to the constitution, but no evidence in support of this assertion was adduced. The result of inquiry was in the opposite direction. Children were not always in a completely satisfactory state for the operation. When they were in a bad state of health vaccination sometimes produced irritation which was followed by illness. The Bill, however, made provision for cases of bad health, and allowed the vaccination to be postponed. If the statistics proved anything, it was that as vaccination was completely performed the chances of human life became greater. Mr. Marson made inquiry into the health of the boys in Christ's Hospital before Vaccination and since it became universal. He found not only that there had been a great diminution in the mortality from small pox, but 1876 that the actual health of the children had improved since vaccination had been practised. It was said they should have a Committee of Inquiry. If the object of the inquiry was to remove prejudice throughout the country, that prejudice was not likely to be removed by the opinion of fifteen gentlemen in that House. They already had, substantially, the unanimous verdict of the medical world on that subject. If that was not sufficient to remove such prejudice nothing would be. It was urged that, to make the law a good one, there ought to be vaccination every seven years. Though there was a small proportion of the medical profession which thought it might be safer for persons to be vaccinated every seven years, experience had shown that, as a general rule, vaccination once in a lifetime was a sufficient safeguard against small pox. His hon. and gallant Friend (Colonel Barttelot) was opposed to the compulsory principle on account of the hardships it entailed on the parents, the medical men, and the registrars. Was there any hardship in compelling parents to have their children protected by means of vaccination against a fearful disease? The difficulty of bringing the parents to the doctors was indeed considerable. It would be well to consider whether the Bill could be improved in that respect. As to the hardship to the medical men, he supposed his hon. Friend must allude to the public vaccinators. But they were to be paid at a higher rate than before, and, as a body, they would be satisfied with the arrangement. As regarded other vaccinators, the Bill would operate as a relief to them. By the present law the medical man was bound to send the certificate of the vaccination. For that he received no pay. Under that Bill the parent would be responsible for the sending of the certificate. All that the medical man would have to do would be to sign the certificate presented to him. As to the case of the registrars, it was simply a question of payment. The Scotch registrars were paid and were satisfied. Only 2 per cent of the persons vaccinated in Scotland were not registered; but the Bill considerably improved the position of the registrars. At present they received nothing for the first entry, and only a payment of 3d. when the vaccination was reported successful. That was a hardship, and this Bill would give the registrar a penny on the first entry, and 3d. when the vaccination was reported successful. Care 1877 was also taken that the registration of the vaccination should in all cases be per-formed by the person who registered the birth. In that way they would secure a more regular system of registration. He could not believe that in these days the House would really be opposed to the principle of the measure. Carefully as the Bill might have been considered by the Department and by the Select Committee, he could well understand that differences of opinion might exist respecting its details. The House could deal with questions of detail in Committee. When they were told that no fewer than 2,000 deaths occurred from small pox in London in a year, he hoped that the House would not sanction a policy of further delay in so serious a matter.
said, he would have been glad if at that stage there had been no occasion for him to say anything except what he wished to say with reference to the details of the Bill, but the somewhat formidable close of the noble Lord's speech made it almost difficult to know whether he should not walk out of the House, and leave the responsibility of such a measure with Other persons. In his concluding remarks the noble Lord very nearly went the length of saying that those who objected to that Bill—which would include its machinery, would be almost guilty of the deaths of the persona who might die from the terrible disease of small pox. He did not think the noble Lord was justified in making such a statement.
§ LORD ROBERT MONTAGU
said, that what he had stated was that if it was proved that small pox was so far preventive that they could prevent it by that method, those who stopped the adoption of vaccination would be guilty of the deaths of 7,000 children a year.
said, he understood the noble Lord stated that they would incur that guilt if they objected to the machinery of that Bill.
If that were not so, he did not know what was the precise meaning of that part of the noble Lord's speech. He agreed that they were not discussing the question of compulsory vaccination which was the law of the land. What they had to consider was whether, aye or no, the Bill would improve the mode in which that law was executed. He did not think they would be much wiser if they had one 1878 more Report on that subject. There were plenty of those Reports before them already. All who had bestowed any attention on those documents must admit that vaccination, whether by public or by other vaccinators, had not been well carried out. Reference had been made to the statistics of the Small pox Hospital, and to the number of persons who had taken that disease after vaccination. The figures relating to cases of imperfect vaccination were no doubt large. He had not understood his hon. Friend (Mr. Barrow) to make any allusion to the number of deaths, but to the number of those who had taken small pox after vaccination [Mr. BARROW: Hear, hear!], which was quite a different matter. However, all the Returns showed that a large proportion of the vaccinations had been imperfect. Then the question arose—was the Bill calculated to secure good vaccination? He did not believe that, as its machinery was contrived, it would or could secure good vaccination. They often found one public department going into another pretty strongly. The noble Lord attributed almost all the failure in that matter to the error in the formation of the districts by the Poor Law authorities. If he was correct in that, it was not a very promising feature in the Bill that all those districts were still to be left under the Poor Law authorities. The guardians were to form them, and the Poor Law Board was to confirm them. If all the mischief had arisen from that arrangement hitherto, that did not strike him as being a very business-like way of getting out of it. But he would not pretend to deny that the Bill took very good care of the Poor Law Board and the Privy Council. It did something, though not much, for the doctors; and the registrars were not absolutely neglected. But he was surprised that when the noble Lord entered into the reasons why that matter had hitherto so far failed he did not at all touch on one important consideration—namely, that they could never get a thing well done if they did not pay a reasonable price. He was, perhaps, so unwise as to think that if we wanted to have a thing well done we must pay a fair price for doing if. If a fair price were not paid, the work, in spite of returns and certificates, was sure to be done in a perfunctory manner, and the result which it was sought to secure would not be obtained. The Bill ought, in the first place, to provide that there should be competent gentlemen to perform the duties 1879 which would devolve upon them under its operation. Ample opportunity should, in the next place, be afforded for ascertaining whether children were in a fit state to be vaccinated, and that the matter was taken from healthy subjects, so that constitutional disease might not be transmitted by means of the vaccine matter; also whether the parents of the child were healthy, as well as the child itself from which the vaccinating matter was taken to be communicated to others. To secure those objects no satisfactory provision was made in the present measure. He would pronounce no opinion, because he did not feel competent to do so, as to the ability of the gentlemen who would be appointed to act under it. But the medical mind which informed the Privy Council had furnished some information in connection with the subject which was rather startling. Those who kept their eyes open in the world must know that many cases of evil and other complaints were alleged to have occurred in consequence of the use of impure lymph. Circulars were sent round to more than 500 medical men in this country and abroad; but he doubted very much, with all deference to the high authority of the Medical Officer of the Privy Council, whether his summing up after the receipts of the answers was well founded. One of the questions put in the circulars was whether there was any reason to believe or suspect that the lymph from the true Jennerian vesicle had been the vehicle of syphilitic or other constitutional affections? In reply to the queries thus put, 7 per cent of the whole number of these people answered in the affirmative that diseases had been so transmitted. Some of the answers returned to that question, such as that of Mr. Bickersteth, the consulting surgeon to the Royal Infirmary at Liverpool, and Dr. Lever, the physician-accoucheur of Guy's Hospital, were of a character which ought to have led the Privy Council to make further inquiries—which, however, they had not done. In such a case no amount of negative should be allowed to override positive testimony. The machinery of the Bill was not likely to accomplish in the country districts the object which everybody had in view—good vaccination. If the vaccinator had no opportunity of seeing the child at the mother's house, or until it was brought to him, or of ascertaining who or what its parents were, he did not see how he would be able to judge whether it was in a fit 1880 state to be vaccinated or not, or was likely to be a pure source from which to take vaccinated matter to be distributed among others. No torture would induce a mother when she took her child among others to tell that anything ailed her baby. Everyone who knew anything of mothers was aware that they would under such circumstances practise concealment, though if questioned on the subject in their own homes they would have no objection to give the information required. The shame of making known the infirmities of herself or her family would keep her silent in public. Even if she did reply to the questions put to her in an open and crowded court she would be tempted to conceal the truth. The medical men would consequently be perplexed and outwitted, and an efficient system of vaccination would not be secured. There was another point on which the Bill was defective. No attempt was made under it to conciliate the prejudices or consult the convenience of the people who were to be compelled to vaccinate their children. The Bill was one of pure coercion which made no allowances for those who were to be brought under its scope. It must not be forgotten that the poor mother was not able to do much within the month after her confinement. The period of three months specified in the measure would press very severely upon the lower classes. It was furthermore plain that the division of the country into districts according to the plan proposed would not be satisfactory. Their medical Reports told them that no district of less than 5,000 people would work successfully, and that 10,000 would be a still better number. If the vaccination districts were to comprise 5,000 persons, how many miles the poor people would have to travel in the country in order to reach a vaccination station! Consider the great inconvenience it would be to a woman to drag her child two or three miles to have the vaccination performed, and be obliged, perhaps, to go a second time for the same purpose. The medical authorities insisted that four punctures at least ought to be made on the unfortunate children. Not only were these four wounds to be inflicted on them, but they were to be brought in all weathers and under all circumstances to the vaccination station; and they were to be compelled to have every one of the wounds opened that matter might be extracted for the benefit of others, so that the sufferings of the children and the cares of the mothers 1881 would be thereby prolonged. Would they by such a course of proceeding carry the feeling of the people with them? If they did not enlist the feeling of the people, all their coercion would not prevent parents from evading the enactments of the Bill. It was provided in the Bill that if a child was not fit for vaccination, the parent could avoid the penalty imposed for not having vaccination performed within a certain period by obtaining a certificate from a medical man to the effect that the child was unfit for the operation. But how was a poor woman to know whether or not her child was in a fit state for vaccination, and how could the vaccinator, when he got to the station, tell whether or not a child—unless, indeed, it had some eruption on the face—was in a proper condition for the operation? If they were to act on the principle of doing as they would be done by, he would ask how they would like to be compelled to take their children a certain distance to be mixed up with other children all waiting to have an operation performed on them? They should allow the same privilege to the poor which they themselves demanded. He saw no difficulty in having the children of poor people vaccinated at their own houses. Such a regulation would get rid of many of the inconveniences he had been pointing out. The expense would not be so very great. The spending of £18,000 or £20,000 would be money well laid out, if this great and important work of vaccination could be carried out efficiently and in accordance with the wishes and feelings of the people. It would be better to pay a trifle more than to let the people think that there was one law for the rich and another for the poor in this matter. He had been told by a medical man that it would be far better for the medical men to vaccinate the children at the dwellings of the parents, because the medical men likely to be vaccinators under any public Act for vaccination would be what were called general practitioners. It would be more convenient for them to have to do with people at their own houses, and at times suitable to both parties, than to be obliged, as they would be under the Bill, to attend each at his vaccination station on a specified day and hour. The noble Lord stated that there were more than 700,000 babies born in the year. As the Poor Law districts did not contain a much less population than 4,000 or 5,000 persons, if the vaccination were divided among the 3,000 medical 1882 men engaged in the Poor Law work, each of them would not have more than four children to vaccinate in a week. These medical officers were going through the districts every day; they would have the opportunity of seeing the parents of the children, and observing the state of health of the children in the cottages they visited. They would consequently be in a much better condition to decide than a vaccinator at a vaccinating station whether the children they inspected were in a fit state for vaccination. He was sorry to have detained the House so long, but he thought it right to explain his views on the subject. Vaccination properly done conferred a great benefit on the people; but if performed carelessly, and with improper lymph, then the result was not a benefit, but a serious evil. He could not vote with those who wished to put off the Bill for six months; but he desired to see its machinery amended. If they could conciliate the minds of people in favour of the purpose they had in view, they would be doing good service. But if they simply tried to drive the people along, it would be found that, under those circumstances, the people would be apt to kick, and ready to evade the restrictions imposed on them.
§ MR. BRADY
said, that as a medical man, he could state that medical men were almost unanimously of opinion that compulsory vaccination was an absolute necessity. In that opinion every one who had carefully examined the Reports made to the House on the working of the present Acts must concur. But it was imperative on the part of the Government that the system of compulsory vaccination should be made no perfect as possible. He held it to be an impossibility that vaccination from pure Jennerian lymph should communicate other diseases to children. The alarm which had been created in the public mind on that score was not therefore justifiable. He quite agreed with the right hon. Gentleman the Member for Oxfordshire (Mr. Henley) that in order to give the public the full benefit of the system it must be fairly paid for. They would be "penny wise and pound foolish" unless the persons employed to carry this measure into effect were fully and liberally remunerated. The great cause of the failure of the Act of 1853 arose from the manner in which the medical officers appointed to carry it out were remunerated. He said when the Bill of 1853 was before the House that the proposed remuneration of the medical 1883 officers was insufficient, and he prophesied that the Act would be a failure. The statement he then made was fully borne out by the admission of the noble Lord that the Act of 1853 was a failure. If the measure before the House were effectually carried out, it would have a salutary effect on the community at large, and he would give it his entire support.
§ MR. LOWE
said, the right hon. Gentleman the Member for Oxfordshire (Mr. Henley) had told them very truly that the question now before the House was not that of compulsory vaccination; it was merely one of machinery. But the right Hon. Gentleman could not resist the temptation which the subject offered, and deviated into the discussion of the very subject which he said was not before them. The right hon. Gentleman bad alluded to a certain question which had been sent round—not by the Committee of Privy Council, but by the Board of Health, with regard to the effects of vaccination—a very proper question, and, as it seemed to him, very properly worded. The question in substance was whether vaccination with lymph from a perfect Jennerian vesicle could communicate any other disease from one child to another? That seemed to be the right way of putting it. Nobody could doubt the effect if they were to take the matter of any disease and innoculate another person with it—they would all be able to answer that question. But the question raised, and which had to be answered, was if after proper care was taken, and vaccination performed with lymph taken from a person having vaccine disease upon another person, any other disease would be communicated than that the operation was intended to communicate? That was the point which seemed to have escaped the attention of those well-meaning but ill-informed men by whom the walls of the city had been placarded in relation to this subject. The right hon. Gentleman told them that the question so proposed had been dubiously answered; he furnished them with the commentary, not with the text. He told them the number of persons consulted, and not what the answers were. They must, therefore, remain very much as they were upon that point. So much with regard to the question of compulsory vaccination. The right hon. Gentleman said nothing was done in this Bill for the convenience of parents. In the 12th clause of the Bill it was provided that where the population was scanty or 1884 scattered, so as to render it a matter of difficulty to perform vaccination within the period prescribed, the time might be extended from three to six months. Was that no convenience to the parents? But the right hon. Gentleman asked, why not vaccinate at the parents' house? For this reason — vaccinating with lymph in a glass tube was more likely to fail than when it was done directly from arm to arm. It was therefore more convenient that the children should be brought together than that the lymph should be carried from house to house. It was a matter of convenience to everybody. The right hon. Gentleman was full of compassion for the innocent children. He talked of four wounds being inflicted on them and then these four wounds were to be re-opened after eight days. But the right hon. Gentleman should also have compassion for the numerous innocent victims of that loathsome disease small pox. The average at this time pointed to 2,000 deaths in London alone and its environs, which might be entirely prevented if only efficient measures were adopted. The right hon. Gentleman should have compassion for the children dying almost as soon as they had entered into life rather than for those who had their arms punctured and had the additional misfortune to have those punctures reopened in order to communicate the safety which Parliamen- had given to them to other children similarly situated. He should keep his compassion for those who did not get the boon, not lavish it on those who obtained it. Then the right hon. Gentleman said this Bill did nothing to make vaccination more effective. Did it not? It increased the fees of registrars, and made vaccination certificates a portion of the general register. A register of vaccination certificates—unlike that of deeds—though not complete, was good as far as it went. Any registration was better than none. Another advantage under the Bill was this—the pay provided for the medical men was better. The right hon. Gentleman descanted much on the necessity of paying medical men on a more liberal scale. He seemed to make it matter of opposition to the Bill that it did not pay them better. But it did. The medical officer was now entitled to a fee of 1s. 6d. where the distance was under two miles, and 2s. 6d. above it. By the Bill he was to receive 3s. He did, then, get increased pay. But there was another great security. Formerly the 1885 vaccinator might be a general practitioner; he must now have a special certificate for performing vaccination. The right hon. Gentleman said that a deputy might be employed in absence of the principal; but the deputy must also have a certificate, therefore it would not matter whether the operation was performed by the principal or by his deputy. The safety of the child was effectually provided for. Lastly, what he most relied on was this—the Bill introduced a new principle. Vaccination appeared to be one of those things to which the doctrine of paying by results could be applied. It was provided by one of the clauses in the Bill that where it should appear on an inspection of the children of any particular district that the number and quality of the vaccinations performed had been such as to warrant it, the Lords of the Treasury might authorize gratuities to be given to the public vaccinators. With reference to the precautions taken to insure the efficiency of the system, it would have been strange if the Bill had been defective in that respect, having been submitted to the very careful investigation of a Committee upstairs, all the members of which had taken great interest in the subject, and paid great attention to it, except the right hon. Gentleman who had left them in a pet. He therefore hoped the House would go into Committee on the Bill, though he did not see how they could materially improve it. The whole subject had been carefully and repeatedly considered; and if this Bill were adopted he did not doubt it would be the means of saving many lives from falling a prey to a most loathsome disease.
§ MR. KENDALL
said, that as chairman of a large union, he had seen great inconvenience arise from the crowding of children at stations to be vaccinated. They were taken, whether it was wet or dry, cold and shivering to these places, and were kept huddled together in a very uncomfortable state. medical men attributed the failure of the act to this. The medical men must be paid a larger sum for vaccinating, and the children of the poor must be vaccinated at their own homes. The grand object was to get pure matter for vaccinating and to stamp out the disease. No doubt country people had considerable dislike to vaccination. This dislike was fostered by the writings of medical men who alleged that the poison that was diffused by means of vaccination was undermining the constitutions of the people. 1886 He did not believe that this poison was so prevalent as was alleged; still it would be better if the children of the poor were to be vaccinated at their own houses, instead of being huddled together in a close room while awaiting their turn.
§ Question, "That the words proposed to be left out stand part of the Question," put, and agreed to.
§ Main Question put, and agreed to,
§ Bill considered in Committee.
§ After long time spent therein,
§ House resumed.
§ Committee report Progress; to sit again upon Monday next.