HC Deb 01 June 1888 vol 326 cc928-53
MR. PICTON (Leicester)

, who had the following Motion on the Paper:— That a Select Committee be appointed to inquire into the circumstances of the epidemic of small-pox in Sheffield and the surrounding district, and especially to ascertain whether its origin can be traced to defective vaccination, or to insufficient sanitary precautions, or to any other causes; also to inquire how far the rapid spread of infection has been owing to the absence of any system of compulsory notification of contagious diseases; likewise, whether the notorious diminution of vaccination in Leicester, Keighley, Dewsbury, and other towns, has been attended by any evil consequences, or whether preventive measures other than vaccination have been found effectual, and, if so, whether they are capable of wider application, said, he trusted, although it would now be impossible for him to ask the House to divide upon the Motion which he had proposed to bring forward, the subject would be deemed of sufficient significance and importance to justify him in advancing the arguments on which, had the Rules of the House permitted him, he would have liked to have taken the opinion of the House. The arguments that he should urge would not, he hoped, offend the strong convictions of any section of the House, however keenly they might feel upon a matter which had given rise to a good deal of bitterness. It was open to the Government to accede to the proposal for an inquiry even if he was not allowed to take a Division, and the proposal for an inquiry did not necessarily commit him or anyone else who supported it to any particular opinion upon the subject of vaccination. He desired that that should be distinctly understood. Of course, they all had their own opinions; he himself had a very different opinion from what he used to hold upon this subject. He felt there was a great deal to be said on both sides of the question; but it was now 17 years since any public and authoritative inquiry was held in regard to it, and during those 17 years very great advance had been made in medical science, and especially in the sanitary branch of that science. During those 17 years a number of medical treatises had been published bearing on the question, and suggesting that many theories formerly held rested upon very insecure foundation. He said this much in order to defend himself against the accusation that he was asking something unreasonable or impracticable, or in a marked manner contrary to universal opinion, and as a reason for asking that an inquiry should be held. It would ill become him to deal with technical medical arguments; he did not profess to understand them as well as some hon. Members who sat near him, and he would rather draw attention to certain facts which had recently come to light, and which did suggest that the country ought to have some more information upon the subject. Let him compare—without insinuating that any inferences could fairly and logically be drawn from the cases, but as a suggestion as to the line of inquiry that ought to be pursued—let him draw attention to the experiences of two towns, the town of Sheffield and that which he had the honour to represent—namely, the town of Leicester. He trusted that no hon. Member would think that the history of the diverse experiences of these towns could be dismissed with a smile. The town of Sheffield, like a good many other parts of the country, was afflicted with an epidemic of small-pox in the year 1871–2, and at that period a very considerable number of people died of the disease. The town of Leicester also was visited in 1872 with a very fearful epidemic of small-pox, and 346 of the inhabitants died from the disease in the course of the year. He asked the House to notice the different impressions produced by this epidemic upon the two populations. In Sheffield, the result was, he believed, that an increased attention was paid to vaccination. It was pressed, of course, by those in authority; the officers were very busy, and the number of vaccinations increased in Sheffield until it stood at over 95 per cent of the population. Sheffield had earned very large bonuses from Government for extra and specially good vaccination. During the last 10 years, £2,223 had been distributed in bonuses for specially successful vaccinations, and during the last year £189 had been granted in bonuses in Sheffield for special success in vaccination. The result of the epidemic in Leicester in 1872 was very different; the people observed that the disease did not, is all cases, respect vaccination, or even re-vaccination, and, whether rightly or wrongly, they came to the conclusion that, notwithstanding all the fuss made about it, vaccination was not an effectual safeguard against small-pox. In the next year, 1873 and 1874, there was a slight rise in the number of those vaccinated; but afterwards, as he should presently show, the number of vaccinations very rapidly diminished. He would like to return to this point in a little more detail, as the argument resting upon it would more properly come in in another part of his remarks. However, the number of vaccinations in Leicester rapidly diminished, as he had said, until last year not more than one child in nine of those who survived to undergo the operation had been vaccinated. Now, of course, those who looked upon vaccination as the only effectual guarantee against incursions of small-pox would acknowledge that that was a very serious state of things, and many people had said that Leicester was like a mass of dried tinder exposed to falling sparks; that when once small-pox made its appearance in Leicester, the epidemic would devastate the whole town. Now, in March, 1887, there were three cases of small-pox reported in Sheffield, and there were three admissions to the hospital. The existence of these three cases attracted but little attention, because, as Dr. Sinclair White wrote in his Report to the Health Committee of the town, a Report dated January of this year, "the disease appears every few months in Sheffield." They were so used to its appearance that these cases attracted very little attention. In November of the same year five cases of small-pox appeared in Leicester in one house. Not only those who wore seized with small-pox, but all the occupants of the house were instantly removed. The patients were taken to the hospital appropriated to such diseases, and the other occupants of the house who had shown no signs of having the disease were removed voluntarily into quarantine. There was no compulsion exercised; but the inhabitants of Leicester were reasonable, and they voluntarily subjected themselves to a term of quarantine in such cases. In the absence of the people just referred to, the house was entirely disinfected and limewashed, and put into such a state that no return of the infection might be feared. That was the experience of Leicester last year; now look, again, at the very diverse experience of Sheffield. The fates of the towns were as different as the methods employed were different. He had spoken of three persons who were removed into hospital in Sheffield in March, 1887; only the patients were removed, no one else was disturbed. But as the patients multiplied, it was soon found that there was no room in the hospital, and the people seized with the disease had to be left in their houses. In April there were four cases, and one death; in May there were 20 cases, and no deaths; in June there were 35 cases, and two deaths; in July there were 104 cases, and three deaths; in August there were 130 cases, and 11 deaths; in September there were 187 cases, and 21 deaths; in October there were 582 cases, and 57 deaths; in November there were 656 cases, and 79 deaths; and in December there were 1,011 cases, and 103 deaths; so the deaths rose to more than 10 per cent of the number of cases. The Committee would observe that the percentage of deaths rapidly rose as the year went on, while the disease increased by leaps and bounds. Dr. Sinclair White issued his Report on January 11th of this year, and said—"At the time of writing the disease is more prevalent than at any time since the commencement of the outbreak." Unfortunately that was so, for, from January 1st to April 9th, there were 3,461 cases of small-pox, and 362 deaths; in all, from the beginning of the outbreak to April 9th, there were 6,202 cases, and 609 deaths. Of course, it was not necessary to enlarge upon the horror of such a visitation as that; those who, like himself, notwithstanding efficient vaccination in infancy, had suffered from the disease against which it was intended to guard, and suffered not once only, but twice, were well aware that there was no affliction that could recall so vividly the terrors and the suspicions incidental to a time of plague. There was no visitation which excited a more cruel conflict between the affections of those who desired to surround the sufferer with faces of sympathy, and the stern duty, on the other hand, which required insistance on a rigorous isolation. The house visited by such a disease was like a pest house, and only those of unusual courage dare go near it. Nor was it personal suffering alone that was to be lamented. The loss of business in Sheffield during the last year and a quarter could scarcely be estimated. Sheffield had had little intercourse with surrounding towns during that time, and he remembered very well the alarm expressed in Liverpool when an excursion train was advertised to run from Sheffield to take people to the Liverpool Exhibition; in fact, he believed, the train was taken off. It was, therefore, from no levity in regard to the terrible nature of the disease he desired to guard against, that he was urging on the House the necessity of inquiry. The Chancellor of the Exchequer, in the course of some remarks upon the interesting subject that had recently been discussed, warned the House against the unsatisfactoriness of any illusory security. Certainly, in matters of disease an illusory security was just as unsatisfactory as in matters of business, and he (Mr. Picton) believed the population of this country were suffering under an illusion, the nature of which he proposed to endeavour to explain more clearly presently, as to the complete sufficiency of vaccination alone as a safeguard against small-pox. He had spoken of the experience of Sheffield during the last year; let them turn again to Leicester. He had said that there was an outbreak of five cases in November, 1887; in the next month, December, 1887, a man living close to the borough boundary, but outside the boundary, went on a visit to Sheffield. He was a vaccinated man, and, therefore, let no argument be founded upon that. When he came back, he certainly had small-pox in his organization, for within a few days he was down with the sickness, and by December 10 the disease became known. Observe, it was outside the borough boundary; the medical officer attending was not bound, by the compulsory Local Act existing in Leicester, to make known the disease; notwithstanding, he felt that so much was at stake that he reported it, and though the patient did not belong to the town, the usual officers visited him and persuaded him to go into the borough hospital. The whole family were taken away, and some of them suffered from the disease afterwards; the house was disinfected, and there was no further extension of the disease in the neighbourhood. On December 14 there was another case, but this time within the town; the same measures precisely were taken, and with precisely the same result. Since the beginning of the year there had been eight more cases, but the disease had always been stamped out; 26 times within a very recent period the disease had been brought within the town from places it could generally be traced to, and 26 times it had been stamped out. Now, they were constantly being told that if Leicester were visited with small-pox, there would be an end of the system adopted there; but the town had been visited again and again by the disease; it had been visited as often as any other town, but the authorities had always succeeded in stamping out the disease. He thought the experience of Leicester did deserve more inquiry than it had yet received. He might be told—he supposed he would be presently, by the President of the Local Government Board (Mr. Ritchie), if that right hon. Gentleman was kind enough to notice his remarks—that an inquiry had been and was being held, and that they had not yet received the Report. But the inquiry was a Departmental inquiry. That might be satisfactory to the right hon. Gentleman, and to those who sympathized with his views, but it was not satisfactory to the people of Leicester, and it was not satisfactory to the growing multitude of people who objected to be compelled to vaccinate their children. Therefore, he urged that the experience of Leicester was deserving of some larger inquiry than it had yet received. He had spoken of the rapid diminution of vaccination in Leicester. Immediately after the great epidemic of 1872, in 1873–4 the rate of vaccination was kept up, but in 1875 it began to go down, and from that period it rapidly fell. Notwithstanding the relentless prosecutions constantly persevered in for many years, by zealous Guardians and magistrates, vaccination rapidly fell until the time when the people exercised local option by electing a Board of Guardians, the majority of whom were opposed to vaccination. Since 1885, there had been no prosecution, and last year, he believed, the number of vaccinations in Leicester amounted to only between 11 and 12 per cent of the births. The small-pox, though it had visited the town, had been very slight, and for several years there had been no deaths at all. Now, he had said that one reason for this change in the habits of the people in Leicester was their observation of the ineffectiveness of vaccination. The people of Leicester were not fatalists; they did not believe they must resign themselves to the evil until they had tried every way of combating it. In 1872 there was a very zealous crusade in sanitary matters which was persevered in for many years. All kinds of old cesspools and objectionable institutions of a similar character were disestablished, and disendowed, as it were, and proper modern appliances were brought, as far as possible into all the houses. Besides that, the compulsory notification of infectious diseases was adopted. There were 49 towns in the country, he believed, which had Acts giving power of insisting upon the notification of infectious diseases, and Leicester was one of them, and Leicester had made very good use of that power. In the year 1881–2 there was a period of test, for, although it was said by Dr. MacVaile that there had been no epidemic of small-pox since 1871–2, there was a very considerable amount of small-pox in the years to which he had just now referred. There were in Loads, he believed, 174 cases, and a very consider- able number of cases of small-pox came into Leicester in the year 1881–2. The health officer showed in his report of that year how the disease was dealt with. He showed that the disease appeared in different localities in the town. On January 5, for instance, a case was reported in a house in Abbey Street. The inhabitants of the house were removed without delay, and the house was forthwith thoroughly, fumigated and disinfected. There was no doubt, the officer stated, that, from inquiries made at the time, the infection in the case was received from the person of a tramp who had rested for a few hours in the house, and had then left the town. On the 7th January, in another lodging-house in the same street, three cases were reported. They were all removed to hospital, together with the other lodgers, and the same means were employed for disinfecting the house; and a strict and daily inspection was kept up for some time afterwards. No fresh cases, however, appeared. Of course, the greatest vigilance and zeal were required to carry out these precautions, but certainly an equal amount of zeal was required to insure compulsory vaccination, and the result in Leicester gave ample ground for inquiry as to how the zeal and vigilance should be directed. The experience was not of one town only. It was well known that Keighley, Dewsbury, and other towns were revolting in an increasing degree against compulsory vaccination. The Medical Officer of the Local Government Board, in his Report for 1886–7, said that 71 per cent of the children born in Keighley were left unvaccinated. There was very little vaccination in Dewsbury, and he was informed that only about 7 per cent were vaccinated. In Oldham, Halifax, Gloucester, Nottingham, Ashton-under-Lyne, and many other places all over the country, the compulsory law had been suspended by the action of the Guardiaus, and small-pox had, by various precautions, been kept down, so that his case did not rest on the experience of Leicester alone. It was often supposed there were only two alternatives on the question of vaccination—either to deny there was any advantage in it at all, or else to acknowledge the duty of compelling vaccination; but he declined to accept these as the only alternatives. He would not say there was no value in vaccination. He attached great importance to the experiments of M. Pasteur, and could not say that in all circumstances vaccination was wholly valueless. It had a certain value; but he contended that tile claim for it as a general and universal safeguard against small-pox had entirely broken down; and besides, as a precaution, it depended upon conditions impossible to realize. He could give reasons for that moderate expression of opinion. Many hon. Members, whose attention had been drawn to the subject by their constituents, had met with the pamphlet of Dr. Wallace, on the registration statistics, and also Dr. MacVaile's book, Vaccination Vindicated. He (Mr. Picton) had done his best to master the arguments of both, and the conclusion he arrived at was that small-pox might, to a considerable extent, be guarded against by careful and effective vaccination over a period of five years, but after that its effect entirely disappeared. Dr. MacVaile, in his book, quoted from the Report of the Registrar General, and gave a table separating the following ages:—Under 1 year, under 5 years, between 5 and 10 years, between 10 and 15, between 15 and 25, from 25 to 45, and from that upwards. Then he took the periods from 1847 to 1853, when vaccination was optional, though strongly recommended. Then from 1854 to 1871, when vaccination was obligatory; then the period from 1872 to 1880, when vaccination was made, if possible, more obligatory, or, at any rate, when it was more effectively enforced. It was a striking fact brought out from those figures that the only age that showed the benefit from vaccination was under five years, and even amongst these children any substantial benefit appeared to be confined to infants under one year. The table showed the mean annual number of deaths from vaccination in the successive periods per million of births. In the period 1847 to 1853 the mean annual death-rate from smallpox of children under a year was 1,617 per million; from 1872 to 1880 the deaths were only 323 per million, which, so far as it went, afforded a successful argument in favour of vaccination. Taking the case of those children under five years in the corresponding periods, there was a diminution from 327 to 186, and between five years and ten years the numbers were 94 deaths per million as against 98 in the last period. Between 10 and 15 years of age, in the first period of optional vaccination, the deaths from small-pox were 109 per million, and in the last period 173 per million. Between the ages of 15 and 25 the deaths under the period of optional vaccination were 66 per million, and in the latter period, when vaccination was obligatory, 141 per million. Of the ages from 45 upwards, the deaths in the first period were in proportion of 22 in the million, and in the latter period 58 per million. So that in the ages over five the mean annual rate of deaths from small-pox had increased considerably, though vaccination was strictly enforced. Those were striking facts that indicated the necessity of inquiry. It was easy to suggest re-vaccination, but by no means easy to carry it out, and a proposal to enforce re-vaccination every five years would be regarded as a Coercion Act more hateful, and would excite more opposition, than any Coercion Act for Ireland. No Government would attempt it. But if it could not thereby guard the people against small-pox, was it not useless cruelty to insist on vaccination in all cases? He had spoken only of deaths from small-pox, not as to the amount of disease. He might be told that the disease had been very much mitigated, and with good authorities on either side he was not prepared to offer an opinion; but at present all that could be fairly urged was that vaccination was a safeguard, though not an altogether effective one, for a period of five years. The argument for the compulsory clause was that if vaccination was compulsory in the case of every birth, then we should become entirely free from small-pox; but the acknowledgment of a very different state of things by medical men of high position strongly suggested the expediency of inquiry. Vaccination, too, was not an entirely safe process. It was too late now to say that no child had ever been killed by vaccination, or that the number of cases of injury was so trifling that no parent need be alarmed. He might refer to the Norwich case, and the lame and impotent conclusion of the inquiry, that the medical officer had used ivory points not quite clean. That same officer had received handsome gratuities the year before, and, in spite of what happened, the bonuses given began rapidly to rise again, and he was evidently a medical gentleman of high repute in his locality. It was maintained by Dr. Collins, in his review of the Norwich case, that it was not proved that dirty ivory points were used, and there was no evidence to satisfy anyjury not prejudiced in favour of vaccination. Dr. Collins occupied a high position in his profession, and had won high honours in the London University, including two gold medals, one of which was for sanitary science. But he only mentioned that gentleman to refer to a quotation in his book from Mr. Jonathan Hutchinson, who, in reference to the notion that contamination could only be conveyed by blood drawn in vaccination, said that in three series of cases, carefully examined, there was no evidence of the lymph being contaminated by blood. Dr. Charles Creighton, a high medical authority, was selected to re-write the article on the subject in the last edition of The Encyclopœdia Britannica, and value must be attached to his words. On page 125 of his work on Vaccinal Syphilis Dr. Creighton states that, as a result of all his previous inquiry and argument, the real affinity of cowpox was not to small-pox, but to the great pox. The vaccinal roseola was not only very like syphilis, but it was the same sort of thing. Now, in that conclusion, Dr. Creighton was not referring to one or two or half-a-dozen cases, but to a very long series of cases. He (Mr. Picton), therefore, believed he had very considerable authority for saying that vaccination was not entirely as safe a process as it was believed. Whether hon. Gentlemen agreed with that or not, they could not convince all parents that it was a safe process. To tell a parent that he must subject a child to an operation which he did not conscientiously believe to be right, but, on the contrary, thought was wrong, and involved very serious danger to the child, was one of the most cruel applications of law that civilization had ever decreed. The only defence for such a law would be that vaccination was the only possible safeguard against small-pox, and that it was a sure and certain preventive. Nothing less than that would justify the law of compulsory vaccination, and that, he was sure, could not be maintained now. Besides, the law of compulsory vaccination was very unequal in its application. He dared say hon. Members had received a letter from a gentleman residing at Hampstead describing his own case. That gentleman refused to have his child vaccinated. He was summoned before a magistrate, who allowed a solicitor to appear for him. He was fined, and the fine was paid, the defendant saying that the fine was of no consequence to him. But, at the same time and place, there were a number of half-starved persons who were unable to pay fines, and who were liable to have their property seized and to be dragged through the streets to gaol for defying the same law. He (Mr. Picton) maintained that whatever might be advanced in favour of vaccination in certain circumstances, it was not an equitable or humane law. The enforcement of law, outside Ireland, depended upon public opinion. In England the law could usually be enforced, because public opinion was in its favour; but the moment there arose a strong opinion against it the law could not be enforced. According to the Local Government Report the opposition to vaccination was spreading and coming to such a head that it might become impossible to enforce the law. He might be reminded, perhaps, of the excessive mortality of the unvaccinated. But there were facts also on the other side. That had been demonstrated as the result of a house-to-house visitation at Leeds, where the disease had been unfortunately severe. How could it be maintained that vaccination mitigated the disease? There were figures as strong on the other side, and therefore it was high time that an inquiry was held to see on which side the truth lay. He had endeavoured, to the best of his ability, to put before the House some of the new facts on which he had ventured to urge the Government—he would not say the House—to give way on this subject, and to be considerate to their weaker brethren who could not see the value of vaccination. If his opponents had confidence in the truth of their opinion, they must know that any further inquiry would only illustrate that truth, and bring it out the more clearly. If, on the other hand, they allowed that medical opinion had to a considerable extent changed, and that it was desirable to know whether a better mode could not be adopted, then he ventured to think they ought to agree to the appointment of a Select Committee of the House to consider the subject. He therefore hoped the Government would take the matter into their consideration with a view of granting the inquiry that had been asked for.

MR. COLMAN (Norwich)

, in supporting the proposal, referred to the inquiry which took place some years ago respecting the alleged deaths of some children at Norwich through vaccination. He had always been of opinion that the conclusion to which the gentlemen who conducted that inquiry had arrived was not at all satisfactory. The inquiry in question turned upon the allegation that the deaths of the children were due to erysipelas, and whether or no that was caused by vaccination. He would quote the following extract from the Report of the Inspectors as to two of the cases:— Although we are unable to assign with certainty a specific source of infection" (with respect to the erysipelas contracted in the vaccination station) "the evidence raises a strong case of suspicion against the freedom from contamination of the lymph with which they were vaccinated. The Inspectors, however, practically exonerated the vaccinator, although Dr. Buchanan, in an appendix to their Report, made some very severe remarks as to his want of cleanliness in the use of the ivory points. It was true that the inquiry took place some years ago, and he was bound to confess that no complaints of similar nature had reached him since, the same vaccination officer remaining at his post. He was glad to find that the hon. Member who had asked for the inquiry (Mr. Picton) had not placed himself in such direct antagonism to the theory of vaccination as had been assumed by his predecessor (Mr. P. A. Taylor) in the representation of that constituency. The former Member for Leicester, who was accustomed to move a similar Resolution to the one given notice of, took a view so hostile to vaccination that he had alienated the support of those who wished that an inquiry should be made into the whole subject. He (Mr. Colman) was not prepared to take up that feeling of hostility to vaccination itself. But knowing as he did how strongly many persons felt upon the subject, he was prepared to say that he thought the time had come when there should be further inquiry of a full and impartial character into the whole question. The Report of the Committee of 1871 upon this subject contained the following:— If the operation be performed with due regard to the health of the person vaccinated, and with proper precaution in obtaining and using the vaccine lymph, there need be no apprehension that vaccination will injure health or communicate any disease. He was very much inclined to think that the opinion expressed by a good many medical men at the present moment was not so strong as to the impossibility of conveying disease by means of the vaccine matter as it was in 1871. He would also point out that it was a very difficult thing to have proper precautions taken in crowded vaccine stations. Some time ago, a friend told him (Mr. Colman) that his child was going to be vaccinated, and that he had a feeling of dread as to the result. The medical man who would perform the operation in this case was a near relation of the parent, and, of course, knew all about the condition of the child, yet the parent was not free from anxiety. He (Mr. Colman) felt when he heard that observation how much greater must be the force of the objection to vaccination by a poor person, in whose case the operator did not know anything at all about the constitution of the child that was going to be vaccinated. Some years ago a friend of his, a magistrate, referring to the compulsory clauses, said he had many cases coming before him of persons who refused vaccination for their children, and he added that he never had convicted them and never would. That gentleman was blamed by his magisterial colleagues for his obstinacy, and his reply was that the law should make vaccination really universally obligatory, or repeal the so-called compulsory clauses. As the law allowed exceptions to be made, his friend said he would not carry out the law, as he contended that all should be treated alike. He (Mr. Colman) was inclined to think that his friend had a considerable amount of common sense on his side. There was one other question touched on by the hon. Gentleman (Mr. Picton), and that was in reference to the partial way this law was carried out. They all knew that there wore institutions in the country established for the purpose of resisting the Vaccina- tion Laws. Some of the societies were in the fortunate position of having a balance at their bankers with which to resist the law. The members of those societies, therefore, were certain to be exempted from the operation of the law, and, as a matter of fact, the law was not put in force against them. The haphazard character of the law in this respect was therefore most unsatisfactory. He thought that any parent who objected to vaccination should be able, at the time of registering the child's birth, to state this objection, and to obtain a certificate of exemption; whether on payment of a small fee, was a question that might be settled by Parliament. That course would lay the foundation for complete statistical knowledge as to the value of vaccination, and was in his opinion desirable, though he was quite aware that a similar proposal had been condemned by the Committee of 1871. In conclusion, he would say he supported the demand for inquiry, because he felt there was a very strong feeling of distrust and of very great hardship in the mind of a portion of the public with respect to these Vaccination Laws.

DR. FARQUHARSON (Aberdeenshire, W.)

said that when inquiries of this kind were asked for, there seemed to be an irresistible tendency to launch out into the general question. His hon. Friend (Mr. Picton) stated that it was generally believed in Leicester that the protection given by vaccination against small-pox was entirely illusory. If that were so, all he (Dr. Farquharson) could say was that it was so much the worse for the mode in which vaccination in Leicester was carried out, because it was undoubtedly the fact that in London, during the last visitation of small-pox, not one single fatal case occurred amongst those who had been properly vaccinated—that was to say, where the proper number of vaccination marks was shown on the arm. Although he did not agree with the first part of his hon. Friend's speech, he was bound to say that in some measure he agreed with the latter part of it, for he believed it would be more satisfactory to the public if a Committee of the House were appointed to consider the special question brought forward by his hon. Friend. If the Government would agree to an inquiry into the two cases of Norwich and Sheffield, he thought it would supply a great deal of scientific information, and to a great extent satisfy the public mind. He thought the inquiries that were held into those cases were of a somewhat hole-and-corner character; they were not public in the sense that their proceedings were open to the public, and there was throughout the stamp of officialism upon them. He did not use the term in an invidious sense, but he could not help thinking that the inquiry suggested by his hon. Friend would be more satisfactory to the public and to the Medical Profession. He congratulated the hon. Gentleman on the system carried out in Leicester. In that borough, compulsory notification of disease was in force, he believed; also, compulsory removal to hospital and compulsory disinfection. He quite agreed with that; but it was very curious that Leicester, in the words of The Lancet commissioner, had no compunction in restricting personal liberty except in the matter of vaccination. He was bound to say that, short of the pole axe, which could not be here applied, he did not think that any more effectual means could be employed for stamping out disease. Of course, the Medical Profession held that these precautions were not alone sufficient; they maintained that vaccination was necessary, and if, as the hon. Gentleman said, the non-vaccination of children in some towns was growing yearly, he was afraid that some day the results would be indeed serious. He had no doubt that everything was done under the Local Government Board by means of inquiry, well and efficiently, but he thought that in addition to that, if some further inquiry were held to satisfy the public mind, it would be of very great value.

Notice taken, that 40 Members were not present; House counted, and 40 Members being found present,

DR. CAMERON (Glasgow, College)

said, he had some difficulty in supporting the Motion of the hon. Member in its present terms. The hon. Member had in his speech entered into questions which had nothing to do with the Motion before the House. Few men in the House had devoted more time than he had to the study of vaccination, and whether the conclusion he had come to were right or wrong, he was convinced that no just conclusion could be arrived at upon statements in half-a-dozen ex parte books. If anyone wanted to understand the matter, he must go into the statistics of half-a-century, and compare the results of vaccination against small-pox with those general laws discovered to exist in connection with vaccination and inoculation in the case of many diseases of the lower animals; and even then, probably he would not be right if he dogmatized like an author quoted by the hon. Gentleman when he asserted that cow-pox had a greater affinity for syphilis than it had for small-pox. He would, however, point out that the method of safeguarding against small-pox might with perfect regard to the theories held by the Department, be inquired into with advantage; and some such inquiry as the hon. Member had suggested might have a great deal to do with improving the system which the Department had to supervize. There were three different systems which might with advantage be inquired into. There was the system which prevailed at Leicester, where there was very defective vaccination, but strict attention to segregation; there was the system which prevailed in London, where vaccination was carefully carried out, without any effective provision; and there was the system prevailing at Glasgow, where there was great attention to vaccination, the re-vaccination of those brought into contact with the infected, and strict attention to segregation. It seemed to him that an inquiry into the results of these three systems would result in demonstrating the superiority of some such plan as that adopted in Glasgow, as contrasted with the system which prevailed in London where it was sometimes almost impossible to get persons removed to hospitals, and where it seemed no one's duty to provide either for vaccination or disinfection. An inquiry which would elicit the results of the three systems might, he thought, lead to the adoption of practical measures, which would tend to the suppression of small-pox and the diminution of the number of deaths from the disease.


said, the suggestion of the hon. Gentleman who had just spoken was worthy of the closest consideration, as there was no one who had paid more attention than he had done to the subject. But the hon. Gentleman, while he said that the speech of the hon. Member for Leicester (Mr. Picton) was altogether outside the four corners of the Resolutions on the Paper, seemed rather desirous of supporting the appeal for the appointment of a Select Committee. [Dr. CAMERON: Not a Committee, but an inquiry.] The hon. Gentleman would see that the inquiry which he desired was altogether of a different kind from that asked for by the Mover of the Resolution, because whatever might be the terms of his Motion, the hon. Member for Leicester had spoken in terms of studious moderation. There could be no doubt, whatever inquiry might be made, a Select Committee of the House of Commons was not a proper Body to make it. The hon. Member who introduced the subject, though not himself strongly opposed to vaccination, yet spoke in the name of a large mass of the people of Leicester who were strongly opposed to it, and believed that it was not only not a blessing, but that it was a curse. Therefore, when the hon. Gentleman asked for an inquiry it was impossible to dissociate him from the cause which, to some extent, he represented in that House. The hon. Member for Glasgow (Dr. Cameron) must be aware that any inquiry into the more efficient employment of vaccination would not be of the kind which the hon. Member for Leicester desired; and that no results which had been anticipated by the hon. Member from the inquiry which he advocated would, in the smallest degree, be likely to remove a single prejudice on the part of those whom he (Mr. Picton) represented. The hon. Member is aware that if the Government were to grant such an inquiry as he advocated, the hon. Member for Leicester, and those whom he represented, would insist that certain Gentlemen who had expressed opinions strongly adverse to vaccination should be placed on the Committee. No such tribunal could ever hope to arrive at a unanimous Report on the subject; things would remain very much as they were, and no satisfaction would be given to the minds of those who supported the hon. Member for Leicester. The hon. Member for Glasgow had dealt with many of the points raised by the hon. Member. The question was brought into the debate as to whether or not syphilis had resulted from some cases of vaccination; and the same with regard to erysipelas, which sometimes occurred altogether apart from vaccination—but, whether or not those results had followed, it was impossible for them to discuss on that occasion. The hon. Member for Leicester had really anticipated very much what he was about to say on this subject. The Government acknowledged that the circumstances of the epidemic in Sheffield were such as called for inquiry, but they said that a Committee of the House of Commons was not the proper tribunal to make the inquiry, which, to be effectual, must be made on the spot by men properly qualified to conduct it. Such an inquiry, though the hon. Member did not attach much importance to it, was now being made, and when the House was in possession of the whole of the facts they would see that a more thorough investigation had never been instituted. The inquiry embraced such points as these—how the disease had arisen, how it had spread, and how far vaccination, or want of vaccination, had been concerned with the prevalence of the disease; a house-to-house visitation was being carried on, and every case of death of an unvaccinated person was being rigorously inquired into. He hoped that when the result of this inquiry was placed before the House it would be seen that the sole aim and object of the Government was to get at the facts and at the truth of the case. The inquiry was not being conducted with any prepossession for or against vaccination. Every single case would be reported on by a medical inspector of the Local Government Board, who had been down at Sheffield for many months, the name of the person, the date, and all the circumstances attending the case being specifically set out.


Are vaccinated as well as unvaccinated cases to be dealt with?


said, every death was being investigated, and all particulars gone into. Of course, it was necessary that there should be a fuller and more careful verification of cases reported as unvaccinated. There would, however, be full inquiry into every case. He was sorry to say that it would be longer than at one time he had supposed before the Report could be laid upon the Table of the House. The investigation had already occupied a large amount of time, and only a few days ago he had received a letter from the gentleman who was conducting it, in which he said that, owing to the large number of cases to be examined into, it was doubtful whether he would be able to send in his Report before the end of next month. It would not, therefore, be possible to lay the Report before the House earlier than that, and it might, perhaps, be somewhat later before it could be done. The hon. Member had spoken about the very sad circumstances which had been in existence in Sheffield before the investigation was made. No doubt the epidemic which had raged at Sheffield for some time past had been extremely severe, and had taxed the resources of the authorities to the utmost extent. Although a good deal of fault had been found at the beginning, yet the authorities in Sheffield had done their utmost to meet the necessities of the case when the epidemic was upon them. It was rather a pity that those precautions were not taken earlier; but he might say that nothing could exceed the vigour with which, when once the authorities became aware of the enormous importance of the question, the disease was attacked. So far from the result of the investigation at Sheffield telling against vaccination, he thought that in all probability there was never a more complete case in favour of vaccination than that which would be presented; and he would give a few figures from the Report of Dr. Sinclair White, the Medical Officer of Health for Sheffield, which would speak for themselves. The number of vaccinated children under 10 years of age in Sheffield was estimated at 82,958, and out of that number 207 were attacked, or one in 400; and of the 207 children only two, or 1 per cent, had died. The number of unvaccinated children under 10 was estimated to be 4,366, and of that number 146, or one in 30, had been attacked, while 70, or 48 per cent of those attacked, had died. If the same proportion of vaccinated children had died as of unvaccinated their deaths would have amounted to 1,330. He was well aware that great precautions had been taken, and could not speak too highly of the way in which the authorities in Sheffield had attacked the disease; but it must be remembered that those who were most strongly in favour of vaccination did not contend that other precautions were not necessary. They did not say that, because persons had been once vaccinated, therefore, for all time to come, a town was perfectly safe against small-pox. No assertion of that kind had ever been made; but what the Government said was that hand in hand with vaccination it was essential that there should be proper means of isolation, of disinfection, and of destruction of everything that could possibly convey small-pox; and they said also, that because Leicester by reason of the precautions it took had been able to show a very satisfactory condition of things so far as small-pox was concerned, it did not disprove the enormous danger that Leicester was now in, and was likely to remain in. He did not know whether the hon. Gentleman (Mr. Picton) had seen a report which had been made quite recently by a gentleman who was well acquainted with Leicester—he meant Dr. Tomkins who was officer of health for Leicester, and who had just written an article in the last number of The Lancet, giving the history of the attack of small-pox in Montreal. He would not trouble the House by reading this Report, but as it was desirable that the people of Leicester and other towns similarly situated should be made aware of danger they were running, it was most important that he should give the House one or two facts in regard to the outbreak in Montreal—facts which had been brought to the attention of the public by the Officer of Health for Leicester. Prior to the year 1885, there had been for many years no case of small-pox in Montreal. There was considerable opposition to vaccination in the town, and the consequence was that there was a very large proportion of the population of that town unvaccinated as at the present moment there was a very large proportion of the population of Leicester unvaccinated. Like Leicester, Montreal for many years had enjoyed immunity from this terrible disease. But in 1885, a man was admitted to the hospital in Montreal suffering from small-pox. He was cured and left the hospital. Within a few days of that a further case arose; but until the month of June the cases did not become very numerous. In July, 46 cases were reported, and in August 239. Then the people became alarmed; further hospital accommodation was called for and supplied, and vaccination was vigorously and rigorously enforced with compulsory removal to hospital of persons attacked; but the disease went on at such a pace that by December of the same year no less than 3,161 deaths had taken place in six months in a population of under 200,000. If the same proportion had died in London of the disease the death would have been upwards of 63,000 in six months. As a matter of fact, however, there were not 63,000 deaths from small-pox in all England and Wales during the period of 10 years from 1871 to 1880.


Does the report to which the right hon. Gentleman is referring give any description of the sanitary state of Montreal?


said, that it did not. He thought the hon. Gentleman would have gathered from what he had said that he did not at all undervalue the comparative security given to Leicester by reason of the excellence of its sanitary arrangements, and he was not prepared to argue that the sanitary arrangements at Montreal were as good as they were at Sheffield; but he was certain that no amount of sanitary precaution would enable the authorities of a town to deal with this disease when it had once seized hold of a place as it had in the case of Montreal. It was absolutely and entirely beyond any measures of that kind, and the only means of dealing with it was a vigorous course of vaccination and re-vaccination. He had given the statistics of the deaths in Montreal. By December, instead of any opposition existing to vaccination in that town, the vaccination station was literally besieged by applicants for vaccination, so much so, that it taxed all the energies of the authorities to regulate the applications and to keep order. No less than 80,000 persons were vaccinated in three months. A remarkable fact, showing conclusively the protection given by vaccination and re-vaccination was that among all the numerous officers who had to deal with the large number of attacks in Montreal not a single one had ever been at- tacked by small-pox. That circumstance was also common to the case of Sheffield, and in connection with Sheffield he would further remark that notwithstanding the prevalence of small-pox there all the large number of Post Office employés in that town were re-vaccinated, and not one was attacked, notwithstanding the fact that they had constantly to be all over the town and to face those dangers which the hon. Gentleman opposite had said that excursionists from Liverpool were afraid to face. He should just like to call the attention of the House to the last paragraph in the report of Dr. Tomkins toThe Lancet with regard to the outbreak in Montreal. This gentleman spoke of the heavy weight of responsibility which in the face of evidence such as this rested upon those who opposed vaccination, and whose influence was greatest upon the poorer and least educated classes of the community who were least able to form a right judgment upon such a question, and who suffered most severely from the disease. He also stated that those who were familiar with this plague looked forward with the gravest apprehension to the future so far as those towns were concerned, which like Montreal contained a large proportion of unvaccinated people. He (Mr. Ritchie) had endeavoured to show, from the report of the Sheffield Health Officer, the results of the outbreak of small-pox in Sheffield as an evidence of the value of vaccination and re-vaccination, and he had shown by quotations from the evidence relating to Montreal what might possibly occur in Leicester some day or other looking at the large number of unvaccinated people who existed there. He had acknowledged that there was in Sheffield a case for inquiry. He had shown to the House that the Government were instituting an inquiry in Sheffield of a most drastic character, the results of which would be placed before the House of Commons, and if, when it was so placed before the House of Commons, it should then be thought that a further inquiry was desirable, it would then be for the House at the time to consider the question; but surely it would be in the highest degree indiscreet on the part of the Government to institute such an inquiry as that asked for by the hon. Member opposite when an inquiry such as that he had referred to was going on in Sheffield, the result of which would shortly be communicated to the House. He was aware the inquiry which was going on was not such as the hon. Member demanded. The inquiry the hon. Member asked for was such as was only asked for by those who were opposed to vaccination, and looked upon it, not as a blessing, but as a curse. No evidence given before such an inquiry would be of value to the purpose of those, or could possibly give satisfaction to those, who were asking for it. It might have a result which the Government would very much deprecate, that of showing on their part some want of confidence in the power of vaccination—a want of confidence which they did not feel, and a want of confidence which was not felt by a very large proportion of the people of this country. The Government, in common with the unanimous opinion of the whole medical profession of this country and of the world, entertained no doubt at all as to the efficacy and value of vaccination, and he did not think they had anything to learn by such an inquiry as that advocated by the hon. Gentleman; and he must, therefore, on the part of the Government, decline to accede to the hon. Member's proposal.

DR. R. MACDONALD (Ross and Cromarty)

said, he wished only to refer to one or two statements made by the right hon. Gentleman the President of the Local Government Board.

Notice taken, that 40 Members were not present; House counted, and 40 Members being found present,


said, he wished to refer to one or two points in the speech of the right hon. Gentleman from a medical point of view. He wished, in the first place, to say that he entirely agreed with the facts put forward in the admirable speech the right hon. Gentleman had made in defence of vaccination. The right hon. Gentleman's facts were admirably marshalled, and he had done great service to the cause of vaccination by his statement; but there were one or two points to which he (Dr. Macdonald) desired to call attention. The right hon. Gentleman stated that it had not been proved that syphilis was capable of being carried into the system by vaccination. He (Dr. Macdonald) wished to point out, in answer to that statement, that medical men were of opinion that the disease was capable of being carried into the system in that way. That such a thing had occasionally occurred was what few medical men doubted. The argument against the general impression was that there was no certainty that the children had not had syphilis in the system previous to vaccination, as it was a well-known fact that syphilis was apt to appear in children at three months of age, and that many children were vaccinated before that age. With regard to his own experience in dealing with vaccination in the North of Scotland, one year they had several cases of small-pox in a country district where all the people were healthy, and where there was not one case in a thousand of syphilis. He had been detailed to vaccinate every individual in the country whom he could vaccinate, and he had gone to the different villages around, and had vaccinated one, two, three, and four at a time, using the healthiest lymph. A short time afterwards he went back and vaccinated about 20 people from each individual of these, and what had been his experience all over the country? Why, he had kept an accurate and correct record of what had occurred, and he had found that now and again here and there about one case in 20 showed severe symptoms—that where 19 of those vaccinated from the same person were all right the twentieth would have a very bad arm and abscesses about the body, what was there to complain of? These 20 individuals were all vaccinated from the same person, and if there had been anything wrong, any syphilitic inoculation, the whole 20 persons would have suffered; but, as a matter of fact, serious symptoms occurred very rarely—as he had said, only in a proportion of about one in every 20 cases. So that vaccination was very frequently blamed in cases where it had no right to be blamed. These were the only points he wished to put before the House. He would recommend the right hon. Gentleman opposite, if it should be his duty at any future time to do anything further in this matter, and he would also recommend the hon. Member for Leicester, to read a book published about a month ago about vaccination, which shattered in almost every point the arguments and statistics of the anti-vaccinationists all over the country, and showed that there was no foundation for them. This book showed that the arguments and statistics of the anti-vaccinationists were copied from one book into another, and were frequently exaggerated in the process; and furthermore, that they were nearly all without foundation. All these statements against vaccination were inventions, and had been handed down from one book to another.