§ Order for Second Reading read.
Motion made, and Question proposed—
That the Bill be now read a second time.
§ *SIR WALTER FOSTER (Derby, Ilkeston)
The first criticism that occurs to me in reference to this Bill is that it is an exceedingly small product for the long labours of the Royal Commission. That Commission existed and worked for six years. It produced a library of information on this subject, and as a result we have a little Measure of five clauses, three of which are the operative clauses of the Bill—the chief clauses of the Bill. I do not make this comment by way of reproach to the right hon. Gentleman who has introduced this Bill. I think that he has exercised a wise prudence in putting it into the simple form I have described, with a view of avoiding the difficulty of criticism, which might otherwise interfere with the easy passage of the Measure. Now, the Bill as it stands has some four points which are important, but it also has some serious omissions. I will deal first of all with those points of the Bill which really form the chief reason for its introduction, and they are alterations in the vaccination law as it now stands. They refer to the age at which the operation is to be performed; the places in which vaccination is to be offered to the parents of the children; the use of a new form of vaccination—of vaccine matter or of vaccine lymph; and, lastly, the sections which deal with penalties. These are the four principal points in the Measure as they occur to one on reading it over. The omissions which I regret, and to which I will call attention later on, are serious matters which the House ought to notice. The Bill really is an attempt on the part of the right hon. Gentleman to introduce a new means of applying vaccine matter to children as a protection against serious disease. It is, indeed, a State experiment with a form of lymph which was known under the name of calf-lymph, but which, on the scientific investigation of a distinguished medical man, Dr. Sydney Monckton Copeman, has been altered to such a form as, I think, preserves not only its old characteristics of efficiency, but does something more. The form in which he proposes that lymph should be used is such as to obtain greater efficiency; it has as large powers of protection, and has certain advantages which the other form 424 of lymph never had, inasmuch as it is not likely to convey any infection of erysipelas or tubercle, or any similar diseases. The discovery to which I refer is that by mixing lymph taken from the calf with glycerine, you are enabled from a single calf to obtain vaccine sufficient to vaccinate from 4,000 to 6,000 children. In some places abroad where this practice has been carried on, as many as 15,000 children, it is stated, could be vaccinated from one calf. This matter, when mixed with glycerine, is not only efficacious for its purpose, but it contains no possibility of any contamination by syphilis, and it is free from any possibility of conveying tubercle or any other disease of that kind. This discovery we can hardly speak of too highly; if experience confirms its value as hitherto, I think it will be a discovery only second to Jenner's in importance in protecting people from the ravages of a most serious malady. I think it is right to say this much, because I think the discovery adds a certain amount of reputation and distinction to the British nation. The glycerinated lymph has been largely used on the Continent, and I think the President of the Local Government Board exercised his discretion wisely in sending two of his principal officers to the Continent to see how it was being applied. In Paris, in Berlin, in Geneva, in Cologne, and in Brussels the use of this lymph has become the habitual method of vaccination. That by itself is a proof of its value, but I can say from personal experience, in regard to children and grandchildren of my own on whom this lymph has been used, that I have been surprised at its efficacy and at the comparatively small amount of inflammation produced by it, as compared with the old form of calf vaccination. One advantage it has in addition to those I have described is this, that it can be produced not only in large quantities, but it can be preserved without losing any of its efficacy. After being kept for six or seven months it has, notwithstanding, given the splendid result of 96 to 97 per cent. of success in the cases in which it was used. I think the right hon. Gentleman has taken a wise step in putting in the forefront of his Measure the introduction of this new form of vaccine, and I congratulate him on the singular fitness 425 of the fact that he who was the first President of the Board of Agriculture should have introduced calf lymph. The nest point to which I refer is that the lymph is to be used under different conditions from those under which vaccination has been performed hitherto. The first alteration, as one reads the Bill, is the age limit. The Royal Commission, reporting on this matter, recommended that the ago should be extended. They recommended that the age should be extended to six months. They advised this extension of the age on the ground of the experience in Scotland. In Scotland it has certainly had a remarkable effect. Deaths from vaccination there are much more rare than deaths from vaccination in England. They are, however, not common in England; they are very uncommon; but the figures as regards England and Wales are these: One death occurred in 14,159 vaccinations in England and Wales, whereas in Scotland only one death occurred in 38,872 vaccinations, so that the mortality in England was more than double what it was in Scotland. The probable cause of that—at all events, one of the causes—was the extension of the age in Scotland to six months. Now, in England, the age at which children are vaccinated is three months. Children at that ago are less able to resist any serious influences that may affect them when they are vaccinated—they have much less resisting power. Therefore the extension to six months would be advisable not only in the interests of vaccination, but in the interests of the children. The Commissioners also stated that they found, from their inquiries in Scotland, that this extension of the age was not a very serious detriment as regards the number of children vaccinated. I think that is an important point made by the Report, of the Royal Commission. The general feeling in this country is this: that early vaccination is useful, because you thereby do not miss so many children as yon do when you leave the time longer. In Birmingham, for instance, I am told that 10 per cent. of the children are lost by removals during the first three months. The opinion of soma advocates of vaccination in Birmingham is that if the age were raised, as is proposed in the Bill, to 12 months, 426 they would probably lose 50 per cent. by removals. This is a strong objection from the point of view of the efficiency and the universality of vaccination. At the same time, I think that the advantages of vaccinating children at a later age are so great that we ought not to be deterred in extending the age, at all events, to six months, if not to the 12 months as proposed in the Bill. There is no doubt that, if you allow the children to get stronger before the operation is performed, you will have less objection on the part of the parents. I think that the extension of the age, even if it goes a little too far, is very important in the present state of the law. I do not intend to say much more about this; it is a matter which I have no doubt will be discussed in Committee, as most points in this Bill will have to be discussed and considered very carefully. The next point in the Bill, which has attracted a great deal of attention outside, is as to domiciliary vaccination. Now, the present system is carried on by the employment of public vaccinators. When vaccination is performed, children are required to attend at stations in order to be vaccinated. This is objectionable in many ways. It, first of all, brings a crowd of children to one locality, which is very often the means of spreading infectious disease among them; mothers are very often kept a considerable time waiting at the stations, and sometimes, as proved by recent cases, deaths occur from erysipelas. The omission of the requirement that children should be brought to the vaccination station would be popular, especially in large towns, but I do not know that the public vaccinators would be equally pleased at having to visit the children, because in some towns going round to the houses to vaccinate children would not be free from certain inconveniences, and possibly discomforts. In the town of Leicester, for instance, there might be difficulty for the vaccination officer in his domiciliary visits, and there are other places in the country where there might be considerable difficulty in carrying out the practice in this way. I hope if the Bill becomes law that the system of stations will not be altogether dispensed with. They 427 might be especially useful in regard to the new system of vaccination with this lymph, because, in country districts, in every village one room could be used, and parents need not go a great distance or a second time. I think that with vaccination stations judiciously maintained, and under the rules of the Local Government Board, a system of domiciliary vaccination could be arranged. It would be a very useful adjunct, and it might be a means of inducing a larger number of parents to allow their children to be vaccinated at a later age. This point of domiciliary vaccination will have to be discussed in Committee in many of its details, with some modifications in the direction I have suggested. Now I come to the fourth point in the Bill, and I am sorry to say I cannot speak of it with the same amount of pleasure and satisfaction as I have spoken of the previous points I have referred to. In regard to the extension of the age, and in regard to calf lymph, I think the right hon. Gentleman has taken a wise step; I think he has taken a step which is likely to make vaccination more popular and to make it less hurtful to the children. I think he deserves congratulation on introducing a new vaccine lymph to this country. With reference to domiciliary vaccination, I think the Bill is proceeding on wise lines. But when I come to the other clause of the Bill I cannot give it the same amount of satisfactory criticism. According to clause 2 an order Tinder Section 31 of the Vaccination Act of 1867, directing a child to be vaccinated, will not be made on any person who has been previously convicted of non-compliance with a similar order relating to the same child. This clause is inserted in order to enable the right hon. Gentleman to meet to some extent the recommendations of the Royal Commission, which practically do away with compulsion. That may not be the opinion of many Members of this House, but I think that any one who will give a careful study to that Report, and consider what effect it will have upon the minds of persons—especially those who have an objection to vaccination—will come to the conclusion that that Report practically killed compulsion in its old form. It did more than that. The Royal 428 Commission suggested in the first place that there should be something done with reference to repeated penalties. The Commissioners made up their minds that a repetition of the penalties was very irritating, did more harm than good, and was probably the cause of the agitation which has sprung up in the country with reference to vaccination. In order to support what I have said, perhaps you will allow me to read one or two sentences from the Report with reference to stronger means of compulsion—We do not stop to inquire whether it would be justified in adopting such a method, for we are satisfied that no such measure, if proposed, would have any chance of acceptance; indeed, few even of the most ardent advocates of vaccination have hitherto made such a proposal. Nor, again, do we think that a proposal to substitute for the pecuniary penalty now imposed a more stringent form of punishment, such as imprisonment, would have any greater chance of acceptance.The further fact remains, and we cannot overlook it, that the administration of the law is in the hands of Boards of Guardians which are popularly elected bodies in the various parts of the kingdom, and that a large number of these are opposed to the administration of the law. No less than one-fifth of the Boards of Guardians are not carrying the law into effect. Thus you have large classes of the community opposed to, and representative bodies refusing to carry the law into effect. I say that the law is an irritating law, which probably does more harm than good. A considerable majority of the one-fifth were against the administration of the law in its present form, and a certain proportion were waiting the Report of the Royal Commission before they decided what they would do. That being the case, I had hoped that the right hon. Gentleman, when he came to meet those difficulties, would have taken another course than the course he has taken. The Royal Commissioners gave him an alternative. While they said they wished to abolish these repeated penalties, they also said that they thought that the honest objector ought to be met and his objection recognised. I am not surprised at their taking this view when we know that not only local authorities do not carry vaccination into force, but that magistrates will not 429 convict the offenders. Whew you come to that position it is necessary to examine the alternative scheme in the Royal Commissioners' Report. They think that there should be another method of netting over this difficulty: they think that a person who hits it serious, honest objection to the law is not likely to be compelled by these penalties to accept vaccination. They point it out in it sentence of great force, regarding the administration of the compulsory sections, which I will quote:—Such a parent has often become a focus of hostility to the Vaccination Laws; his neighbours and his friends take his side; he is regarded as a martyr; and he and they frequently become agitators against the Vaccination Laws.The agitation in this country has been fostered by fining, and forcing the law on the people who are honest objectors, and the result is that they and their neighbours and friends are all banded together. There are whole unions in England where the law has fallen into disuse. Taking the whole country, we have at least 20 per cent. of the children going without vaccination altogether. There is another even greater cvil. Every public vaccinator is required to vaccinate efficiently and thoroughly for the protection of the child brought to him, but I am sorry to say that there are a number of practitioners, members of the profession to which I belong, who have been willing to do sham and inefficient vaccinations and to give certificates. Thus we have a large number of the 80 per cent. of vaccinations recorded in England and Wales that are useless vaccinations as regards the protection of the infants; and so we see a very large number of people who have been inefficiently vaccinated put down as catching small-pox, find bringing the whole system of vaccination into undeserved disrepute. I think that is a condition of things that is very undesirable, and it is the result of the compulsory sections of the existing Acts. There are practitioners who are vaccinating hundreds of children every month, and who make a single mark, and then give a certificate of successful vaccination. That certificate is practically worthless, and ought not to be accepted, and I hope in one clause of this Bill the Local Government Board will 430 take powers to ensure that vaccination, whether done by the public vaccinators or private vaccinators, shall be done in such a way as to be an effective protection against the disease from which it is intended to save the child. I was led into this digression for a moment in speaking of the proposal with regard to honest objectors. The alternative the Royal Commission proposed was that the honest objector to vaccination should have a way of escaping from being prosecuted by the law. The passage is—After careful consideration and much study of the subject, we have arrived at the conclusion that it would conduce to increased vaccination if a scheme could be devised which would preclude the attempt (so often a vain one) to compel those who are honestly opposed to the practice to submit their children to vaccination, and at the same time leave the law to operate, as at present, to prevent children remaining unvaccinated owing to the neglect and indifference of the parent. When we speak of an honest opposition to the practice we intend to confine our remarks to cases in which the objection is to the operation itself, and to exclude cases in which the objection arises merely from an indisposition to incur the trouble involved. We do not think such a scheme impossible.There is the alternative before the right hon. Gentleman which he did not take. He did not take it, I daresay, because he was anxious, as the guardian of public health in this country, to get its many children vaccinated as possible. I believe that to-morrow he would get more children vaccinated if he would accept a conscientious declaration on the part of the honest objector. Is it not an extremely illogical position for the Government to take up, that a man who suffers two penalties should escape the duty he owes to the law? To a rich man a fine of 30s. or £2 is of no consequence, but it falls very heavily on a poor man who may have an income of only £1 or 30s. a week. That man, if he conscientiously objects, ought to be allowed in a Court of Justice to make a declaration before a magistrate; and I think the law ought to be administered in such a way as to involve the dropping of compulsion altogether. Compulsion, as it is at present, is shown to be ineffective, is shown to be doing harm by the way in which children are vaccinated, is not adding credit to the law, and is giving dissatisfaction throughout the country. If 431 the local authorities will not carry out the powers of compulsion, I think we are better without them. We can go to those people who have honest objections to have their children vaccinated and empower them with proper formalities to declare that they are opposed to vaccination. In that way I believe you would have more children vaccinated than at the present time. And you would have this additional advantage: you would make no martyrs from the enforcement of the law. Every man who is imprisoned for a breach of the Vaccination Law makes hundreds of converts—or perverts, if you like to term it so—to his view of the Vaccination Law, and he does more harm to the efficiency of the vaccination in his district than the most rigid administration of the law would do in the opposite way. That being my view, I feel bound to say that I hope in Committee—I do not propose to vote against the Second Reading of this Bill, because even if it passes as it stands it is an improvement on the existing law—we shall have an opportunity of moving to omit a portion of the section in question, so as to bring about an alternative by means of which a man, having a conscientious objection, can escape any penalty under the Vaccination Acts. I should be glad to see in this Bill a clause introduced which would repeal the penalties altogether, because I believe, by careful action on the part of the officers, by the good-will of the medical profession, and by the spread of the knowledge of the benefits of vaccination, more good can be done than by the compulsory clauses of any Act of Parliament. It is unnatural to Englishmen to yield to force, and the sections which impose penalties, and may lead to imprisonment, have done a great deal of harm, and I hope a wiser course will be taken before the Bill passes through Committee. Having said so much with reference to these points in the Bill, I want to refer to one or two things which are omitted in it, to the disadvantage of the general health of the country. In the first place, there is nothing in the Bill about re-vaccination. I do not want to make re-vaccination compulsory, but I do want to see some system introduced in this country by which re-vaccination may be offered to the whole community at suitable times. This is done in Continental 432 countries with great effect. In Germany—which is an example to us in some respects—since the re-vaccination laws have been introduced, there has been a remarkable diminution in the prevalence of small-pox. Since the law of 1874 was introduced into Germany, which goes in for compulsory vaccination, and re-vaccination at the age of 14, remarkable results have been attained. The death-rate, which used to be, under the old law, not less than 309 per million, fell from 1874 to 1892 to 15 per million, and during the last 10 years has been only seven per million. These are wonderful results, and ought to make the President of the Local Government Board, and the representatives of the public health departments in this country, anxious to introduce this beneficent system of re-vaccination, without making it unpopular by penalties and compulsory clauses. During the last year of which we have records there were in Germany only 27 deaths from, small-pox out of fifty millions of people, and more than half those occurred on the frontiers of Germany, near countries which are less protected, in consequence of the nonexistence of the vaccination laws; so that you have on all hands the most striking record of the benefits of this system of doing vaccination a second time. Now, there is one illustration with reference to another country which, I think, it is important I should refer to, and that is with reference to Italy. In Italy the death-rate used to be about 355 per million. In 1888 compulsory vaccination was introduced into Italy, and re-vaccination at the schools, and in 1891 and 1894 the death-rate, fell from 355 per million to as little as 65 per million; so that, you see, the enforcement of this beneficent system of repeating the operation has had a most marvellous effect upon the reduction of the death-rate from this loathsome disease, not only in Germany, but in other places. Now, I think these points indicate that we ought, in this country, to have some system of re-vaccination, and I hope the right hon. Gentleman will turn his attention to that point, and will propound in Committee some clause to be introduced into the Bill by means of which re-vaccination will not be enforced on individuals, but 433 will be offered to individuals at the age of leaving or of entering school, so that you may have these protective influences against serious disease in this country as in other countries. In this Bill you have a clause which gives the Local Government Board powers to modify the regulations of vaccination officers. The clause says that the Local Government Board shall have the same power of making rules and regulations with respect to public vaccinators that they have with respect to vaccination officers. I should like that rule extended to all persons vaccinating, so that you may bring under the same rules all private practitioners who vaccinate, in order to keep up some control of the method in which vaccination is performed. If you simply make a rule for a few hundreds who vaccinate publicly, and make no rule for the thousands who vaccinate privately, you will have the same system of sham vaccination going on which exists, to the discredit of the country, at the present time. I therefore hope the right hon. Gentleman will be willing to give even larger powers to the Local Government Board, so that we may have the opportunity of insisting that this operation, when it is done, is done properly, so as to protect the interests and guard the health of the community against the propagation of so grave a disease. I have thought it right. Sir, to make these comments on the Bill as it stands, because I think the Bill is one which, while it improves the law, has omitted to do certain things which ought to be done for the public health. I hope the right hon. Gentleman will not only have the credit, before this Bill is placed upon the Statute Book, of doing something to improve vaccination by the introduction of this new glycerinated lymph, but that he will also make the law more popular, and the vaccination of children more efficient, and thus add to the general well-being and health of the community.
§ *SIR WILLIAM O. PRIESTLEY (Edinburgh and St. Andrew's University)
Mr. Speaker, I have listened with great interest to my hon. Friend opposite, and I agree with almost all that he has said on the subject. I may, 434 perhaps, begin by congratulating the President of the Local Government Board on having had the courage to grapple with so thorny a subject and one so beset with difficulties. I fear, however, that the Measure before the House only touches the fringe of a large subject, though I gladly acknowledge that it is an honest attempt to meet some of the difficulties at least, and so deserves support. I therefore venture to offer one or two criticisms, not in a captious spirit, but in the hope that, having had some experience, I may possibly strengthen the hands of the President of the Local Government Board, and possibly also add to the suggestions which have been made by my Friend on the opposite side of the House. It is high time that something was done to improve the law of vaccination. I believe it is computed that one-third of the children in England and Wales, or about 300,000, are unvaccinated, and, with the object-lesson of Gloucester before us, the House can understand the mass of explosive material there is in any given town or community. Now, Sir, with the permission of the House, I will say one or two words on the various points which were laid before the House on the introduction of the Bill by the President of the Local Government Board. First, we will take the glycerinated lymph, which is about to be introduced. I cannot help thinking that my right hon. Friend was most fortunate when it was necessary to do something to improve the law, in the circumstance that glycerinated lymph had been discovered. When I say "discovered," I may point out that the discovery was made by Dr. Copeman Monckton in 1891, and yet hitherto it has never been adopted systematically in this country. I think it is most likely, when once adopted, to remove many of the objections of the parents, which I have no doubt are conscientious, arising from the fear that by the introduction of foreign material into the bodies of the children harm may be done, shall show presently that these fears have been greatly exaggerated, but, at the same time, if the proposed system is once adopted I think it will tend to allay a great many apprehensions on the subject. Now that it has been adopted in other countries, I have been frequently asked how it is, seeing that it was 435 discovered in this country, its adoption in Great Britain has been so long delayed. Well, Sir, I can only say it is probably because we have, in the first place, no Minister of Public Health in this country, and no municipal laboratories. In other countries they have not only a Minister of Public Health, but they have municipal laboratories. In Germany, and elsewhere, a great deal more attention is paid to matters of public health than in this country. Sir William Turner, the distinguished President of the Medical Council, and who was towards the end of last year in the United States, tells me that the laboratories for public health in New York are so magnificent that they are real palaces, and the organisation is so perfect that there was not a single case of small-pox. This is the more remarkable because of the great number of immigrants arriving there from European countries. Science is not well treated in this country. You would scarcely credit it, but the Royal Society of Edinburgh—the centre of the best scientific work in Scotland—has failed, year after year, in getting a paltry £300 from the Exchequer; and this, notwithstanding that the revenue amounts to something like £107,000,000 in the present year. Now, this glycerinated lymph has been investigated in Berlin, Paris, Geneva, and other centres by that excellent officer of the Local Government Board, Sir Richard T. Thorne, and Dr. Copeman, and so far as they are able to make out, the results are very satisfactory. The treatment of the lymph is very simple. Dr. Copeman found that if he mixed 50 per cent. of sterilised glycerine with distilled water, and added calf lymph to it, it did not impair the efficacy of the lymph, but destroyed all other germs. The diseases most feared by parents from vaccination are syphilis, erysipelas, and tubercle, but there is reason to believe that the number of cases where these diseases have been communicated by vaccination has been greatly exaggerated. Dr. Robert Lee says that out of his experience of 30,000 cases in the Sick Children's Hospital, there was only one in which syphilis was supposed to have been transmitted by vaccination, and this 436 was not clearly proved. The Royal Commission, in its Report, says—If, in some instances, syphilis has been inoculated with vaccination, it cannot have been to any substantial extent.Concerning erysipelas, à priori, one might expect some increase of mortality if vaccination were a frequent cause of death. When I look back upon my own early experience, I am almost aghast when I think of the risks we ran in those days. It is only since the celebrated M. Pasteur's time that we have come to understand what germs of disease are carried in the atmosphere, cling to our clothes, and are contained in the dust that lies upon our tables. M. Pasteur taught that the smallest puncture in the skin might fester, not because of the state of the blood, but because of germs inoculated from without; and yet I have seen the table in the vaccination room covered with dust, possibly containing the germs of erysipelas. Notwithstanding these risks, little damage was actually done in the process of vaccination. Dr. Cory, in his evidence before the Royal Commission, said that there were two deaths in 32,000 cases, and one per cent. of sore arms. He further says—You would be astonished to see the hideous stuff some people will make in a pot, and put on the places; they cannot leave the vesicles alone.Punctures have been poisoned again and again by mischievous dressing; and possibly, if the requisite precautions had been taken, there would have been even fewer cases. The Commission also says—We believe that the cases in which the virus of erysipelas is conveyed at the time of vaccination are rare.There is one very curious fact which I should mention to the House. Both erysipelas and syphilis produced a higher mortality at Leicester than in England and Wales generally, where vaccination was practically discontinued. With reference to tubercle I need not detain the House, because there is very little evidence indeed of harm from that. The Commission says—We do not find any facts to warrant the assertion that the increased mortality from tabes mesenterica and scrofula, or any part of it, was due to vaccination.437 Now, Sir, admitting that some harm has been done by vaccination, it is not easy at any time to do a great amount of good without some modicum of harm. All medical efforts are relative; if they were absolute no one would die. If you were to look into the history of many remedies you would find that misadventures may attend all of them. It is well known, for instance, that no one can avail himself of the administration of chloroform to relieve pain without some risk of death. I believe if you were to inquire into the history of those two very simple domestic remedies, Epsom salts and castor oil, you would find that in some cases the effects had gone much farther than had been intended or expected, and harm had resulted. The great thing in the use of all remedies is to do the greatest amount of good with the least possible harm. It is entirely a question of proportion. Unfortunately, there are always people possessed of what I may call the "anti" mind, who, with a perverse ingenuity, fasten on the harm and refuse to look on the other side of the question. A distinguished scientific friend of mine once said: "I always try to teach my pupils to think to scale as well as work to scale." Now, these people who are always dwelling on the harm do not think to scale. They concentrate all their attention upon the mischief. They anatomise it, they put it under the microscope, they magnify it, photograph it, and allow it so to fill the field of their mental vision that they cannot see its surrounding relations, and so lose all sense of proportion. No better example of this tendency always to dwell upon the harm is to be found than in the case of the remedy of M. Pasteur recommended for rabies. All the cases that went wrong under his treatment were instantly reported in the papers, and dwelt upon and magnified in their importance, and yet the agitators persistently ignored the fact, pointed out by M. Brouardel, that in former days 50 per cent. of the people bitten by dogs mad, or supposed to be mad, died from hydrophobia, while under the Pasteur system the mortality is reduced to 1 in 400. This is a remarkable result, and I believe, these statistics are perfectly true. There seems to me to be some analogy between 438 the practice of vaccination and the slight harm it brings us occasionally and railway travelling. A great many people go to Scotland every year, and yet a number of people are killed and wounded by the way every year. We are, however, I take it, not going to stop railway travelling because accidents occasionally happen. The obvious thing is to stop the accidents and prevent the misadventures. The Report of the Commission says, in reference to the harm that comes from vaccination—A careful examination of the facts shows that although some of the dangers said to be attendant on vaccination are incontestably real and not inconsiderable in gross amount, yet, considered in relation to the extent of the vaccination work done, they are insignificant in amount.The wonder to me is not that sometimes damage occurs, but that misadventures are so rare, especially when we consider the ignorance of the parents, and when we consider also how incautious concerning antiseptic precautions medical men were in former times. Experiments made by Dr. Monckton Copeland have shown that the germs of such diseases as syphilis, erysipelas, and tubercle were destroyed by glycerinated calf lymph. He mixed sterilised glycerine and water with the lymph, and found that it destroyed all extraneous germs, but did not impair the efficacy of the lymph. The advantages, I may point out, therefore, are the following: in the first place, the glycerine destroys all the microbes, but does not destroy the efficacy of the lymph; secondly, it may be preserved for an indefinite time without losing its strength; and, thirdly, if diluted, it will suffice for a much larger number of children. In Berlin one calf was enough for 15,000 vaccinations: so that it is a very economical process. Fourthly, I may point out there is no necessity to continue arm-to-arm vaccination in the vaccination room, and, besides this, there is no occasion to open the vesicles, which may bring about contamination in some cases, and so produce sore arms in some form or other. On this subject of glycerinated lymph, I notice that there is a gentleman writing to the journals who is already on the warpath. Mr. A. W. Hutton writes that, 439 some years ago, Sir George Buchanan gave the history of an outbreak of impetigo in the island of Ringen, in which 342 persons were affected, and it is officially acknowledged that it was due to the use of glycerine lymph from the Government depôt. Well, Sir, it is not very long since we knew how to make pure glycerine, and in its impure form Sir George Buchanan may well have expressed his disapproval of the use of glycerine for the purpose indicated. Let me take the second point of my right hon. Friend the President of the Local Government Board, that of domiciliary vaccination. This, I have no doubt, will have a beneficial influence. In the first place, domiciliary vaccination will tend to lessen the objection many people have to vaccination. I saw only the other day an account in which it was stated that there was only about three per cent. of vaccination defaulters in Scotland as compared with England and Wales. The people of Scotland appear to be much more teachable, or else they are much more intelligent, and this deserves to be noticed as one of the results of better education. There are one or two advantages which domiciliary vaccination possesses which I should like to point out to the House. It saves the risk of children being infected by aggregation. A great number of poor children kept waiting in the vaccination-room are exposed to the danger of catching scarlet fever, measles, and whooping cough, and when they come to be vaccinated in this room it may, from the crowding, be full of germs of disease, and the vaccination is very likely to go wrong. At the same time, I hope that the President of the Local Government Board will not do away, as my hon. Friend opposite has said, with the vaccination station on certain days, with certain precautions. The atmosphere must be purified, and great care taken that no children are allowed to mix with the rest who are suffering from any infectious diseases. I think one of the great advantages of adopting this domiciliary vaccination will be that medical men will be able to persuade a great many parents who have had con scientious objections before, and who have probably been "got at" by agitators, to have their children vaccinated. They will then be able to represent to 440 the parents the advantages of this treatment. Certain objections have been pointed out in various medical journals, but perhaps I may be permitted to say that these objections are not all valid. No doubt this Measure will give a great deal more work to those who do the vaccinating. They will have to visit the homes of the poor, and, consequently, the vaccination officers should have increased pay. It has been said in some constituencies the people would not receive the vaccination officer very favourably, and one hon. Member has said that they might possibly do him some bodily harm. But I may point out that in Chicago, where there are all sorts and conditions of men, and where many of them are keenly alive to repressive restrictions, the system of domiciliary vaccination has had the very best possible effect, and very few children remain unvaccinated. In Chicago they produce very effective vaccination by persuading people to submit their children to it. Some years ago I was told that in France all the parents were paid a very small sum for bringing up their children to be vaccinated. This plan was very successful, and it was surprising how some parental scruples as to dangers of vaccination were removed by the few sous paid. This leads me to say that in the Bill brought in by my right hon. Friend there is no provision made for paying medical men when vaccinating private patients. This was pointed out as a very desirable thing in the Report of the Commission, paragraph 530, of which I have made a note. I think it is very desirable, where the patients are too poor, if the Local Government Board can see their way to do it, to make some arrangement of this kind. It must be remembered that a great many of the patients attended by medical men are very poor. They can only just afford to pay for medical attendance, and they shirk having their children vaccinated if they have to pay for it. I believe that if some arrangements were made by which, if certain results were obtained in vaocination, the private practitioner could be recompensed, as well as the vaccination officers, vaccination would be very much promoted, and so many children would not escape vaccination. When done by the family's own medical man it would 441 diminish the reluctance of the mother, and it would also diminish the number of those who escape vaccination. There must necessarily be some safeguards. All children must be vaccinated in one way, and not allowed to escape a perfect vaccination. The number of insertions should be uniform, and the results submitted for inspection. I may point out that it is not necessary to inspect every child, but sample cases might be taken of thorn, and, when the inspectors send in their return, then they might receive the same fee for vaccination as that which is paid to the Public Vaccinator. The third point in the Bill is the extending of the age limit to 12 months, as in Germany. I see no great objection to this so far as the risk to the children is concerned, because, judging from the experience of Germany, it seems that children are less liable to take small-pox when unvaccinated during the first 12 months. The objections which have been raised to this may have some validity, but I think they may be overcome. In the first place, it is said that when the child is older the vesicles after vaccination are much more likely to be injured by creeping about and coming in contact with contaminating matter. Then, it is pointed out that the removals of children under 12 months would make it very difficult to follow them up. I think, on the whole, that I should be very much disposed to adopt the suggestion which has been made, that instead of the period being extended to 12 months, it should be limited to six months. This, I think, would save a great deal of trouble. It would make the time more uniform, and there is no valid reason why there should be one time in Scotland and another in England. In saying this, I think we ought to supplement any default it brings by vaccinating all unvaccinated children who are attending school, and we might very well imitate Germany in this particular. In Germany all children must be vaccinated on entering school who have not been previously vaccinated, and all must be re-vaccinated at 14 before they leave school. This is also the case at Chicago, which is under an entirely different régime politically, and where people are much more free to do as they like. In Chicago no children are 442 permitted to attend school who have not been vaccinated. It must be remembered that the early infant is an object of much sympathy, and compulsory vaccination when the time comes for going to school may be looked upon with less aversion than at an earlier period. If a child were offered vaccination at the time of entering school, and again upon leaving it, it would be less objectionable, and fewer children would escape being vaccinated. This leads me to say that there is no provision in this Bill for re-vaccination. One of the points brought out in the evidence before the Vaccination Commission, and which was forced upon the minds of the medical profession by experience, is that vaccination is not absolutely permanent, but that a re-vaccination is necessary for better protection, although the effect of primary vaccination never entirely passes off. The celebrated Dr. Jenner, to whom we owe so much, was wrong when he supposed—with pardonable enthusiasm—that vaccination, gave an absolute immunity throughout life, and that this remedy for small-pox would last during the whole life of a patient. It has been proved as the result of observation, that when 10 or 12 years have elapsed after the first vaccination, although it may modify small-pox at subsequent periods through the whole life, it will not protect a person from taking smallpox again later. I think, therefore, that there ought to be some provision made for re-vaccination as well as for primary vaccination. In reference to re-vaccination I may point out that the anti-vaccinationists have made much capital out of the fact that a number of people at Gloucester who had been vaccinated took small-pox, but they omit to state that the largest proportion of them were over 20 years of age, and were far away from the time when their vaccination was more efficacious. In point of fact they had not been re-vaccinated. In the recent epidemic at Middlesbrough the same thing came out, and it may be noted that nearly half of those unvaccinated (46.6 per cent.) died, and only 8.2 of those who were vaccinated. Here again the greatest number of vaccinated who were attacked were over 20 years of age, when the protection of infantile vaccination was less than at the earlier period. It 443 may seem hard to impose upon parents an obligation to which they object, and of which they do not see the value, but the object of the State should be the welfare and the happiness of the greatest number, and the good of the children above all things. The danger of allowing a large number of children to remain unvaccinated has been very clearly seen at Gloucester, and I may be permitted to point out that, just in proportion to the stringency of the vaccination regulations, so was small-pox diminished and protection furnished to the community. Medical men think that vaccination is just as essential to the welfare of the child as the provision of food and raiment. The fourth question is the proposal to remit penalties after two prosecutions. Around this must centre the largest amount of discussion. Some will say it is a weak-kneed measure, and others will say that it is tyrannical. Certainly, as my hon. Friend opposite has said, it is very illogical. We never think of letting a man off who has been tried for drunkenness and convicted once or twice, but we fine him again. And so you would not be disposed to let a parent off who had neglected a child. If he had been fined once or twice, you would certainly tine him a third time, a fourth, or even a fifth time, if necessary. Medical men think vaccination is absolutely essential for the welfare of a child, as it will prevent disease, and man think there certainly ought to be no remission of penalties; at any rate, there ought to be something which is almost equally efficacious. Still, the object of the Measure, as I understand it, is to promote vaccination and not to make martyrs, and there is much to be said on both sides of the question. The recommendations of the Commission certainly need very careful consideration before this Bill is passed. It is confessedly a very difficult subject. I think I should be disposed not to remit penalties absolutely, but, when the parent has a conscientious objection to vaccination, not to give it up altogether, but to suspend it for a time—say till the schools days come. This would be a great, deal more logical than the remitting of the penalties, and it would be very much the same thing as telling a 444 prisoner to come up for judgment when called upon, If vaccination were offered again, when a child enters school, parents might not then object. I have just one further suggestion to make, and it is this: All parents who insist that their children shall not be vaccinated, and who have persistently ignored it, should, after being fined once or twice, be compelled to subscribe to isolation hospitals. Isolation hospitals have been again and again proposed as an alternative to vaccination, and no doubt they are the next best thing, though they will not take the place of vaccination. I certainly think that all parents who have conscientious objections should at least pay something in the way of insurance against the dangers they might bring upon their families and the community generally when vaccination is not properly carried out. I am sure this will appeal to some of my friend's upon county councils and to sanitary authorities. I believe it has been calculated that to properly equip a hospital for small-pox patients for all the purposes required it would take about £300 a bed. Now, taking into consideration the number of patients who were stricken with small-pox at Gloucester, and accepting the estimate at £300 per bed, the sum required would amount to £24,000, and in Middlesbrough to £54,000. Consequently, it is only fair that those people who produce this danger should pay for the safety of the others. There is another point. I think the administration of the law should be transferred to the sanitary authority, and should not be left to Boards of Guardians, who are too often in conflict with the law. Boards of Guardians have been constantly shirking their duties. They are allowing vaccination to go by default in the case of a large number of children, who come to be a source of danger not only to their own locality, but to the whole of the community. I feel quite sure that if vaccination were entrusted to the sanitary authority it would be much more efficiently carried out. I trust that I shall not be out of order if I say a few words calling attention to the proofs of the efficacy of vaccination and the necessity for such a Measure as that which has been introduced. Scientific men have 445 great difficulty in understanding the attitude of those who object to vaccination, for if any scientific fact is ascertained beyond all reasonable doubt it is the potency of vaccination to prevent the spread of small-pox. And yet the agitation against vaccination has assumed very large proportions. The anti-vaccinators are really the noisiest faction. They have had the field almost entirely to themselves. The anti-vaccinator, by his perfervid oratory and facile pen, has reiterated again and again statements, many of which are too absurd for refutation. They have stated half-truths and denied the advantages of vaccination. They have exaggerated the dangers and disported the figures, and in this way an amount of antagonism has been stirred up against vaccination out of all proportion to what it ought to have been if the thing had been grappled with earlier by those who knew better. It was the same spirit arising from ignorance which produced the riots in Bombay quite recently, when stringent measures were attempted for staying the plague in India. It was the same kind of ignorance which made the populace in Sicily threaten to bench the medical officers who, at the risk of their lives, went out there to try to stop the ravages of cholera. I cannot understand how anybody who has studied the history of vaccination can doubt its efficacy. Some of the objections to vaccination have been very absurd. In the early days of vaccination a child at Peekham was said to have lost its former natural disposition, which was absolutely changed to the brutal by vaccination, so that it ran about on all fours bellowing like a cow, and butting with its head like a bull. In another case it was said that "a lady's daughter now coughs like a cow, and has grown hairy all over her body." Such an agitation can easily be set on foot, for there are people always to be found with oblique mental vision, and they generally adopt more than one "anti" subject. It seems that the possession of high intellectual attainments is no bar to the acceptance of "anti" ideas, and the same person may run the whole gamut of "anti" agitations, and even throw spiritualism into the bargain to make up the complement. These people seem quite incapable 446 of weighing evidence, even when their intellectual capacity in other directions is not deficient. Sir, history is full of examples of crowds of people being led off in wrong directions by organised agitators. We all of us have just had recalled to our minds, by his death, the case of the Tiehborne Claimant. A great number of people believed in him, and even many scientific men believed that he was the real claimant. They had no capacity for weighing evidence, and therefore they were led wrong. A celebrated quack doctor at the beginning of the present century, St. John Long, who was twice tried for manslaughter, boasted that he had produced most remarkable cures, and people ran after him in crowds. One person, a peer, actually swore that he had seen him draw pints of a fluid like mercury from a patient's brain as the result of his treatment. All this is deplorable. Possibly these "anti" agitations in a liberal country may be regarded as the tares and weeds springing up amongst the stronger wheat, hoe growth of liberal ideas. No effort should be spared to convince those who have taken an antagonistic attitude, and who are likely to be swayed by evidence. The voluntary efforts that have been made recently in this direction are very great, but I think the Government ought also to do something in this way. They may put something in the hands of every anti-vaccinator in the way of a statement showing what is in favour of vaccination, and what evils it averts. I cannot understand anyone who has studied the history of smallpox and vaccination doubting its efficacy. People are too apt to forget what happened before vaccination came into practice. I remember my grandfather telling me that at the beginning of the present, century every third person he met in the street was marked with smallpox. Now we very rarely see anyone marked with small-pox. It is to be recollected that when we meet people marked with small-pox they only represent those patients who have recovered, and an enormous number of these lose their sight. Sir Gilbert Blaine said that at least two-thirds of those who went to the Indigent Blind Asylum had lost their sight through small-pox. Mr. Simon, the respected former medical 447 officer of the Local Government Board, said that small-pox ravaged more fiercely than the most ruthless of wars. It exterminated whole races, and in Quito, according to De la Condamine, it destroyed upwards of 100,000 Indians. The annual ravages of small-pox in Europe alone, before vaccination was adopted, was half a million, and it was a constant source of terror to all civilised nations. Ago was no security, for a man might have it at 70 years of age. The disease was so loathsome that when a patient died with it there was a very panic towards the corpse. As indicating what has been done by vaccination, I may quote from my distinguished predecessor Lord Playfair, who years ago made one of the most convincing speeches as to the value of vaecinationtion ever made in the House. Lord Playfair, in 1883, pointed out on the authority of Dr. Farr, the Registrar General, that the mortality during the last century was 3,000 per million for the whole country. In the first forty years of this century vaccination was promoted by charitable agencies, and under this the mortality from, small-pox fell to 600 per million. In 1841 Parliament gave funds for gratuitous vaccination, and by 1853 this mortality had fallen to 305 per million. In 1853 vaccination was made compulsory, but without the means of enforcing it, yet the deaths again fell to 223 per million. In 1871 the Board of Guardians were compelled to appoint vaccination officers, and since that period the average mortality has been 156 per million. Voluntary efforts reduced the mortality in the last century from 3,000 to 600 per million; gratuitous vaccination reduced it to 305; obligatory laws, inefficiently administered, reduced it to 223, and the same laws under vaccination officers effected a further reduction to 156 per annum. The hon. Member for the Chesterfield Division proposes that this Bill should be read a second time this day six months. The hon. Member has written a pamphlet on this subject, but I understand he is not opposed to vaccination, because he has had his own children vaccinated. This contention nevertheless is that the Gloucester epidemic was due, not so much to a lack of vaccination, as to insanitary conditions, to polluted water, and 448 sewer malaria, and he asks, if that is so, whether small-pox may not be prevented by improved sanitary conditions without vaccination? Well, more than a thousand Medical Officers of Health have expressed an opinion to the contrary. The hon. Member proposes another Commission to inquire into this, but such a proposed is merely beating the air. There is no doubt that sanitary conditions will prevent the spread of some diseases, notably typhoid, but sanitary conditions will not prevent unvaccinated children taking small-pox if there is infection about, and will not prevent a child getting the disease in a public conveyance, such as a cab or an omnibus. The Vaccination Commission pointed out that, although sanitary conditions are generally improved throughout the whole of the land, there is no diminution in measles, scarlet fever, and whooping cough; and the Commission—fails to see why improved sanitary conditions should enable children to escape attacks of small-pox and not those of other zymotic diseases.There are one or two other points in the Report to which I wish to refer as convincing evidence of the value of vaccination. One has been alluded to by the hon. Member opposite, who pointed out the remarkable diminution of small-pox in Germany as the result of vaccination, I may remark further, that, in the Prussian Army, previous to 1835, isolation was rigidly tried, yet the small-pox rate was higher than in the whole general population. In 1834 every soldier, whether previously vaccinated or not, was vaccinated, and then the proportion at once was reduced until, in 1869, it was, in the Army, exactly .11 per 10,000, as compared with 3.7 in the civil population. The French Minister for War wrote that, in the war of 1870–71, the Germans, being well vaccinated, lost only 459 men from, small-pox, while the French Army, being less well vaccinated, lost 23,400, a loss, which, the Minister for War added—would have been saved to France by carefully carrying out obligatory vaccination. Does not this loss represent quite an army in itself?449 In Germany, with its population of more than 50,000,000, since 1885 only 1,164 deaths from small-pox have been recorded, and this notwithstanding its extended frontiers. For those who object to the eccentricities of the figures, I take, another example, in connection with the Gloucester epidemic In the case or Wotton Asylum there were 800 patients within the city of Gloucester. It was not in the best sanitary condition, and the patients were so overcrowded that Dr. Craddock reported that, in some wards they "were packed like herrings in a barrel" While the superintendent was debating whether the whole of the patients should be vaccinated became small-pox was raging round, it suddenly broke out in the asylum, instantly all the patients were vaccinated or re-vaccinated. Out of the whole, only four were attacked, and this was among a people of low vitality, and who were not living in the best sanitary conditions. What could account for this except vaccination? Here is another case equally striking. It is in connection with the outbreak of small-pox at Warrington; and Dr. Saville reports that, of 800 re-vaccinated individuals in the garrison, the only sufferer was a militiaman? who had not been re-vaccinated. And yet the inmates of the garrison mixed freely with the townspeople. In the same place an outbreak in the principal ironworks, where some 1,400 hands were employed, was suddenly checked within a fortnight by re-vaccination. Fully one-third of the population of Warrington were re-vaccinated, and not one of all the number contracted small-pox, although the whole town was permeated by the infection. Such incidents appeal especially to what is called the "man in the street." In conclusion, I will give a brief summary of the conclusions of the Commission as to vaccination. These, were (1) it diminishes liability to be attacked by small-pox; (2) it modifies its character, (a) less in amount, and (b) milder; (3) protection is greater in the year immediately succeeding the operation, and may cover a period of nine or 10 years; (4) effect rapidly diminishes after the period of highest protective influence, but is considerable afterwards, and is, possibly, never altogether 450 lost; (5) power to modify severity lasts throughout life (6) re-vaccination restores protection, and, therefore, should be repeated; (7) where most thorough the protection is greatest. After seven years' investigation, the recent Commission has confirmed in every important particular the great advantage of vaccination to the community; it has extended and, enlarged the evidence; and if it has shown certain limitations to the great good vaccination brings, and made clear that in some few cases evils have resulted from vaccination, it has also proved that such, cases are infinitesimal as compared with the number of people vaccinated, and it has indicated how these misadventures may be avoided. I have been repeatedly asked what I have to say of the evidence of certain exports—distinguished men—who gave evidence against vaccination before the Royal Commission. Well, Sir, this is eminently a question of authority, but it is quite possible to pin faith on the wrong person; and I think none of us will be disposed to place the names of those scientific gentlemen who gave evidence before the Commission in opposition to such names as Lord Lister, Sir James Paget, and Lord Herschel, who was chairman of the Commission, was trained in weighing evidence, and who was so thoroughly convinced of the value of vaccination that he thought there could be no question about it. The dissentient report of the Commission showed great ingenuity in the manipulation of figures, and I only wish that ingenuity had been expended on a better cause. The dissentients went into the question prejudiced, and were not likely to alter their minds by any amount of evidence. Finally, Sir, I trust the Measure proposed by my right hon. Friend the President of the Local Government Board may, in some degree, have the good results expected from it, and may further the practice of vaccination, which most scientific men consider one of the most beneficent of discoveries. It is injurious to the Commonwealth when ignorance takes the form of opposition to the teachings of science, and it is lamentable to reflect that, so long as public knowledge lags behind, the wise 451 and prudent must suffer from the ignorance of those who know no better. It is especially lamentable when innocent children must suffer from the ignorance and prejudice of their parents.
To leave out the word 'now,' and at the end of the Question to add the words 'upon this day six months.'
§ *MR. THOMAS BAYLEY (Derbyshire, Chesterfield)
My hon. Friend, the Member for the Ilkeston Division, in his speech criticising the Bill, does not—as I understand—agree with a single clause of the Bill, and is dead against the fundamental principle of the Bill; and yet he tells us he is going to vote for the Second Reading. The hon. Member for Edinburgh and St. Andrew's Universities did all in his power to damn the Bill with faint praise. I regret that the right hon. Gentleman who has charge of this Bill was not more explicit in opening the Debate. In discussing a great Measure like this—and it is a great Measure—the House wants to know, in the first place, what it is going to cost the local authorities to carry it out, and whether the taxpayers or the ratepayers are going to pay the cost. The House may be pretty certain that if people are to have the choice, as this Bill gives them the choice, of being vaccinated at a public institution or a private house, they will prefer to be vaccinated in a private house, and will not go to a public institution. That is perfectly certain. And how is the cost to be met? There is no indication in the Bill whether we are going to have a Government grant to cover the cost, or whether it will come out of the rates and taxes. Another very important point is that the Bill does not in any way deal with the question of who is to administer or put the law in force. The recommendations of the Vaccination Commission, which sat for seven years, and took evidence on all aspects of this question, are not in any way carried out by the proposals of this Bill. The Commission stated that there were other things to be done besides vaccination for stamping out small-pox. They also recommended a complete system of compulsory notification, but there is not a word in this Bill about that. They recommended 452 immediate hospital isolation, but again there is not a word of that in this Bill. They also reported in favour of better sanitation. If sanitation had nothing to do with small-pox, yet these very able gentlemen, who had been considering this question for years, clearly thought it had. But there was not a word in the Bill about improved sanitation. A few years ago, I was as strongly in favour of vaccination as anybody in this House, but a perusal of the Government Reports raised doubts in my mind; and I am beginning now to believe that we are at the wrong end of this question, and that sanitation, isolation, and cleanliness in the habits of the people will do more to destroy small-pox than vaccination. The hon. Baronet, who has just sat down, has referred to Gloucester. I myself visited Gloucester after the epidemic, and will tell the House what I saw with my own eyes. The drainage in this city of 40,000 people went into the river Severn, below the bridge. There was a tide which took this drainage five or six miles beyond a pumping station, which pumped the water from the Severn into the mains, and the people of Gloucester were washing themselves with and were drinking this contaminated water. The hon. Member for Gloucester is present, and if I am wrong he will be able to contradict me.
§ MR. C. J. MONK (Gloucester)
It is not the case that water was pumped from the Severn for drinking purposes.
§ MR. BAYLEY
The water pumped from the Severn was the ordinary drinking water. That is what I was told. This went on for five or six months. The Government Report on the epidemic, signed by Dr. Sydney Copeland, states that in the month of August "a most mysterious thing occurred." A small-pox epidemic continued from January or February till August. There were 122 cases in July, and in August the epidemic had absolutely ceased—Dr. Copeland says "mysteriously ceased." But Dr. Copeland ought to have inquired what was the nature of this mystery. The explanation was most simple. In the month of July the city of Gloucester opened new waterworks, and the whole city had a good, wholesome supply of water. Immediately that was done the epidemic "mysteriously ceased." Another very extraordinary 453 thing is that, according to Dr. Copeland's report, 190 re-vaccinated persons in Gloucester took the small-pox. We have understood, up to the present time, that a person re-vaccinated was safe for the remainder of his life, or, at least, for a number of years; but here were 190 persons who took small-pox only a, mouth or two after re-vaccination. Then we have the case of Middlesbrough, which, I believe, has the largest percentage of vaccinated persons of any town in the United Kingdom. Yet in Middlesbrough there has been a very serious rise in the rate of small-pox. With regard to the Bill before the House, it is a Measure that will please nobody. It is not a good Bill for Leicester, and Leicester will have nothing to do with it. The Commission on Vaccination reported that they wished to see a less severe law put into force more uncompromisingly than at present could be done. But how is that going to work at Leicester, or at any other town where there is a majority of the guardians against compulsory vaccination? This is how I understand it is going to work, First, the persons will be summoned before the magistrate, and then there may be an adjournment, and a medical man will be sent to the house to try and persuade the Parents to have their children vaccinated. If that is not successful, the parents will appear a second time before the magistrates, and there will be another adjournment until there is a conviction, causing people who object to vaccination a considerable loss of work. The objectors can be fined to the extent of £1, and if they decline to pay, they can be imprisoned, precisely in the same way as under the present law. The only difference is that once fined or imprisoned they cannot be fined or imprisoned again. But the law can be so administered that they can be punished almost indefinitely by the loss of work, as the result of constant adjournments of the hearing. They recommend it on those lines. They say it would conduce to increase vaccination if any scheme could be devised which would preclude an attempt—"Preclude an attempt!" This is merely "an attempt" to get the people vaccinated. They recommend that we should preclude any attempt to compel those who are honestly opposed to the practice to submit their children to vaccination. Now, there are a great number of people who 454 do so object, and they are growing in this country, and they will continue to grow if legislation, of this kind is not repealed, and unless legislation is made absolutely free on the lines of the recommendation of the Committee—from for those to have the benefit of vaccination who consider it beneficial, and free for those who honestly believe that they are injuring their children, and the future lives of their children, by having them vaccinated. That is what is really wanted by the country—doing away with these repeated penalties and with imprisonment. Now, what is it that this Bill proposes? Lock at Clause 4. I have already explained how it will work. A man can be had up any number of times before the magistrates and fined. [The PRESIDENT of the LOCAL GOVERNMENT BOARD: No, no! That is wrong, unless he has been previously convicted.] Unless he has been previously convicted, Exactly. The magistrate can adjourn the case any number of times until he is convicted. Thai is the point. There are in this Act provisions against what is called repeated penalties; but there are no provisions against repeated penalties against anyone who has been had up repeatedly before the magistrates. The real question at issue between us in the country and here in this House is, whether we are to continue the old system, and, perhaps, almost the last, of the old and worn-out systems of imprisonment and fines for those who have a conscientious opinion, rightly or wrongly held, and held firmly by people who believe that they have control of their own bodies and of their children, and that they should not allow the State or anybody else to tell them what they should do with their bodies or with their children. It is a question of the freedom of parents, to do what they think right with their children—freedom of conscientious opinion, freedom from imprisonment and fine. Mr. Speaker, as this Bill does not carry out the recommendations of the Royal Commission, and does not do away with imprisonment for conscientious belief in this country, at the end of the Nineteenth century, I beg to move the Amendment which stands in my name.
§ MR. W. C. STEADMAN (Tower Hamlets, Stepney)
Mr. Speaker, I rise to second the Amendment of the right hon. Member for the Chesterfield Division of 455 Derbyshire. It is not my intention to travel over again the ground of the hon. Gentleman opposite who has spoken in favour of this Bill, because my knowledge of vaccination is only limited to my own experience as a poor law guardian in the East End of London, and I am one of those guardians who absolutely refused to carry out the present Acts of Parliament dealing with vaccination. Although medical men, from their point of view, may state that the decrease of small-pox is due to vaccination, on the other hand, I, as a layman myself, claim that that is absolutely wrong. For the last five years the Mile End Board of Guardians have refused to carry out the Vaccination Act, and with what result? In 1893, we had 116 cases and 8 deaths; in 1894 we had 42 cases and 4 deaths; in 1895 we had 49 cases and 1 death; in 1896 we had 1 case and no death, and in 1897 we had no cases at all. Well, now, that is a demonstrative proof that vaccination, so far as its compulsory character is concerned, has absolutely failed. Some hon. Members may smile, but these are figures which I challenge them to dispute. There has been a decrease in the deaths of children under the age of 12 months, and for seven years past the average of these deaths has been less for the whole of London, although the death-rate in the East End is higher as a rule. The people of Mile End are strongly opposed to vaccination, and when candidates come forward for the Poor-Law Board of Guardians, let them label themselves Liberal or Tory, they absolutely stand no earthly chance of being elected unless they are opposed to compulsory vaccination. The effect of the attitude of the Mile End Board of Guardians upon this question has been to convert the boards in the adjoining districts of Bethnal Green, St. George's in the East, Poplar, and Whitechapel; and those boards to-day are absolutely refusing to carry out the compulsory Vaccination Acts. In 1895 the small-pox broke out in the Salvation Army shelter in Whitechapel. In that case, the Local Government Board sent one of their officials down to the Mile End Board asking them to open their vaccination station at hours apart from the certified hours. But what happened? What reply did the Mile End Board of Guardians give to the official sent down by the Local Government Board? Why, Sir, 456 they absolutely refused to open the station. It was at the period of the water famine at the East End of London, and we said to the official of the Local Government Board, "What we want is not vaccination, but water in the East End of London," with the result that the epidemic did not spread, but very soon disappeared. We have in Mile End to-day, Sir, 16,000 children unvaccinated, and out of 13 deaths that have occurred during the last five years four were of children who were not vaccinated. If any hon. Members dispute my authority, I have here, Sir, the certificate of death of one of those children, whose death was laid to the door of vaccination, and not to their want of vaccination. In the whole of East London we have 25,131 children who were born during the year 1896 in the ten Parliamentary divisions of East London, and out of that number only 7,980 were vaccinated. Now, however much medical men may sneer as to the reason of the decreasing population, so far as the sanitary point of view is concerned, I claim that it is due to the Public Health Act dealing with London, and passed by this House in 1891, that small-pox has decreased. The reason for that Act coming into force—and, mark you, I speak with regard to the poor law guardians as a member of a district vestry—was that the vestries were largely manipulated by the house-mongers of the district, whose sole object was to evade our sanitary laws, and the sanitary inspectors were practically given over to them. It was not until that Act came into operation that we were able to compel our local authorities to carry out the Sanitary Acts, with the result, which is due to those Acts being in operation, that small-pox is practically a thing of the past, so far as London itself is concerned. [An HON. MEMBER: Who passed those Acts?] I do not say who passed those Acts—this House passed them. But, Sir, while hon. Members opposite are so willing to take credit for passing the Act of 1891, one hon. Member, in his speech this afternoon, practically accused the working class of being open to bribery, so far as vaccination is concerned. What did the hon. Member opposite say? He stated that in France when working men were offered a few sous to have their children vaccinated they had them vaccinated. But the 457 workmen of this country, who go to prison rather than have their children vaccinated, are not the men to be tempted by the bribe of a few sons. But as a matter of fact, Sir, we have had fewer cases of small-pox of late than we had for two hundred years, and yet the Vaccination Acts have not been enforced. Isolation, in conjunction with sanitary arrangements, has been the means of preventing epidemics of small-pox in this country. But, Sir, if the right hon. Member who introduced this Bill into the House of Commons this afternoon had the courage of his opinions—he believes either in the principle of vaccination, or he does not believe in it—if he believes in the principle of vaccination why does he not have the courage of his own opinions and not add one penalty and put the law into force if a man will not have his child vaccinated? If, however, he does not believe in the principle of compulsory vaccination, then why introduce this Bill into the House at all. It is wrong in principle and bad in practice. It has failed, Sir, in its objects in the past, and upon this Measure medical men themselves differ in opinion upon this question as much as lawyers do upon Acts of Parliament that have been passed through this House. I feel certain that nothing will satisfy the great majority of the population outside this House but the total abolition of the compulsory Vaccination Acts. And what is more, Sir, it is—like other Measures brought forward by Gentlemen on the opposite Bench—class legislation. Because a workman cannot afford to put his band into his pocket and pay one or two pounds in the shape of a fine, the result is that he has to go to prison, and going to prison means, perhaps, loss of his employment, which brings suffering upon his wife and family. Bui it is easy for a rich man to put his hand into his pocket and pay as many pounds as the law demands of him as a fine. For these reasons, Sir, I hope the House will reject this Bill.
§ THE PRESIDENT OF THE LOCAL GOVERNMENT BOARD (Mr. H. CHAPLIN) Lincolnshire, Sleaford
Mr. Speaker, the Government have no cause to complain of the manner in which this Debate has been conducted, or of the hon. Member, or his friends, for, so far as I have been able to judge, the House, with the exception of the mover and seconder 458 of the Amendment—so far as I have been able to collect its opinion upon this subject, while the Bill has been subjected to natural and proper criticism, it appears to me to have met with a very considerable amount of general support. Sir, the hon. Member who moved the Amendment complained greatly of me because, as he said, I had made no speech at the beginning of the Debate this afternoon, and because he was left in perfect ignorance as to how the expense of this Bill was to be paid—whether it was to be paid by loan, or grant, or out of the rates—and because I had not said a word about the questions of notification and hospital isolation. May I be permitted, Sir, to say that I had already stated on one occasion that the cost of this Measure would be met precisely as the cost of vaccination has been met in the past? With regard to notification, the hon. Member, I think, can hardly be aware of the practice in respect to notification at the present time. Of course, notification would be given under the Notification of Diseases Act. That Act is compulsory in the metropolis at the present moment. It is true that it is optional in other districts in the country, but what are the facts with regard to those very districts? The Act is practically in force at the present time with regard io 28,000,000 out of the whole population of 29,000,000 in this country. Again, Sir, with regard to the compulsory provisions for hospital isolation, under the Public Health Act the local authorities may provide—and can provide, if it is so desired—hospitals for that purpose now. Under the Isolation Hospitals Act it is the fact that county councils everywhere at the present moment have absolute power to form districts, and to require the provisions of that Act to be put in force subject to certain restrictions. The hon. Member was very anxious to know what would be the cost. He said there would be a great deal more work under the Bill, and there must be more remuneration for the officers employed, and, consequently, the cost of the Measure would be greatly increased. Well, Sir, I have looked into that question, and perhaps I may take this opportunity of saving a word with regard to the increased remuneration of the officers who are to be employed, for that is a subject upon which they will naturally take 459 very great interest. Now, as to remuneration, both vaccination officers and public vaccinators and subject at present, and they will be in the future also, to the approval of the Local Government Board. Their duties will be increased to same extent, no doubt, and I quite recognise that there must be some alteration in their remuneration. What I propose is this: that both classes of these officers shall be remunerated in future by two methods. First, by a payment, based on the number of births, to cover all their general duties; and, secondly, by a payment in each case for successful vaccination. To encourage this—and we think it very desirable to encourage it as far as is possible—we consider that the fees for the latter duty should be higher than those for the former. With regard to the amount of those fees, in the first place, it is a matter, we conceive, for arrangement between the local authorities and the officers themselves whom they employ; and it is subject in all cases to alteration and to approval by us at the Local Government Board. Circumstances, of course, vary greatly in different districts of the country, and in all those districts peculiar circumstances must be taken into consideration. In addition to this, under the system of awards which exists at present, and which will also be continued in the future, there will be the award which is certified at the present time by the Local Government Board, and which is paid by the county councils, and which is not to exceed, under the existing law, one shilling in the case of each successful vaccination. Well, now, with regard to the cost of all these operations, I have looked into this matter, and what I find is this: I do not wish to delay the House, for I know there are other hon. Members who desire to speak, longer than I can help, but I find that the amount raised by public rates in the country at the present time is practically a sum of about £35,000,000 of money, and the whole cost of vaccination expenses at the present time is £78,000 a year. Now, if the cost of vaccination is doubled—and I think that is extremely unlikely—it would amount to an addition of less than half a farthing in the pound on the rateable value, and even if it were trebled it would be less than a farthing. Well, now, Sir, I pass from that question for a 460 moment only to others which have been raised by hon. Members. What I have to say is this: that the absolute efficacy of vaccination for the prevention and mitigation of small-pox appears to me to have been absolutely demonstrated by the experience, not only of this country,, but by the experience of the world. Take, for instance, Germany, which has been spoken of this afternoon by the hon. Gentleman opposite, the Member for the Ilkeston Division. By the Report of the Commission which has recently sat, it is shown that they have gone fully into this question, if anything more were needed, and, after the interesting speech of my hon. Friend the Member for Edinburgh University to which we have listened this, afternoon, I hope, Mr. Speaker, that the hon. Member will acquit me of anything in the nature of discourtesy if I decline to enter into any argument upon the subject. The hon. Member appears, however, to be under a complete misapprehension as to the working and operation of the Bill, and, therefore, it may perhaps be convenient to the House, and very desirable, that I should say just a word or two, as briefly as I can, upon what will be the procedure to be adopted under the new regulations. Now, in the first place, the registrar—I am speaking now of compulsory vaccination as opposed to the existing system—in the first place, the registrar of births and deaths at the time of a birth gives information to the parents as to his or her duty with regard to vaccination. He also gives, at the same time a list of births to the vaccination officer, and it will become, under this Bill, the duty of the parent to have the child vaccinated within twelve months from that time. The parents may employ either a private or a public vaccinator, as they please. If the parent requires the attendance of the Public Vaccinator his duty will be to give notice of the time at which he will attend; and whichever officer is employed, if he vaccinates successfully, his duty is to send a certificate to that effect to the vaccination officer, who already has the list of births, and by comparing that list with the certificates which he receives, he will be able to ascertain at once who has, and who has not, been vaccinated. If the parent has employed neither the one nor the other officer by the end of nine months, then 461 it becomes the duty of the Public Vaccinator to call at the residence of the parents and to offer to vaccinate the child, giving due notice of the time at which he will do so. I have heard it said that the home of the parents is to be invaded against their will, but there is no provision and no intention whatever of that sort contained in this Measure. The duty of the vaccinator is to present himself and to offer to vaccinate the child, if it is desired, and is thought convenient that he should do so. Then, if at the end of twelve months, the Public Vaccinator having duly made this offer, the child has not been vaccinated, then the parent will become liable to prosecution, but the Public Vaccinator must give notice before taking any proceedings. Now, I may also mention that, under the powers which we possess already, we propose in future to make it the duty of the vaccination officer to institute the necessary proceedings. That will be a change from the present practice with regard to vaccination to which I, for one, attach very considerable importance. [Mr. BAYLEY That is not in the Bill.] I said under the powers which we possess already. The hon. Member does not appear to be aware that under past Acts of Parliament the Local Government Board possesses powers of the very widest description. It will also be the duty of the public vaccination officer to take proceedings for the enforcement of the second penalty if it should be necessary for him to do so. Something has been said about the difficulty in connection with removals, in consequence of the age being postponed to twelve months, but it will be part of the vaccination officer's duty to make every inquiry as to these removals, and to ascertain the districts to which the removal has been made.
§ MR. H. LABOUCHERE
Will the right hon. Gentleman be good enough to state who pays for these prosecutions?
§ THE PRESIDENT OF THE LOCAL GOVERNMENT BOARD
They are paid for out of the rates. They are paid for by the local authorities who take these proceedings. Of course, if they do not take them, there is nothing to pay. If they do, the cost is paid by those who 462 take the proceedings. I think I have now said sufficient with regard to the procedure under the Bill. Now, Sir, I turn to what is, to me, a much more agreeable subject.
§ MR. J. SAMUEL
Will the right hon. Gentleman explain whether the new vaccination officer will have power to take proceedings without the authority of the Guardians?
§ THE PRESIDENT OF THE LOCAL GOVERNMENT BOARD
Certainly, unquestionably, under the regulations we propose to make.
§ THE PRESIDENT OF THE LOCAL GOVERNMENT BOARD
Of course they will. Now, Sir, I come to the speech of the hon. Member for the Ilkeston Division. The hon. Gentleman was good enough to express very considerable approval of the Bill, but he also dealt with some omissions in the Bill to which he referred, and I think it will be convenient if I take the omissions to which, he referred first. And, first, he dealt with the question of re-vaccination. I entirely agree with the hon. Gentleman in the importance which he attaches to re-vaccination. I should have been glad myself to have included provisions for re-vaccination in this Bill, but I am still more desirous than I am of doing that of getting the present Bill passed into law during the present Session, and I frankly own that I had some fears as to whether, if I were to overload the Bill with an unnecessary number of new provisions, I might fail altogether in my primary object. With regard to re-vaccination, the evidence and experience of Germany has been very remarkable, but on one point it appeared to me that the Member for the Ilkeston Division was not quite consistent, because, while holding up to us the example of Germany, he was opposed to a continuance of compulsion. The hon. Member forgot that those very remarkable and striking results in Germany had been obtained under a system of compulsory vaccination. Then, sir, the hon. Member was in favour of some further provision, I think, for the inspection 463 of children when they enter school. In that way the hon. Member thought that children might be inspected. To both of these I attach quite as much importance as the hon. Gentleman does himself. I do not know that it might not be possible to make some additions of this sort. Then I come to the question of private practitioners, and there I am perfectly well aware that a recommendation was made by the Royal Commission to the effect that private practitioners should receive fees for every successful operation of vaccination which they performed. The hon. Gentleman asked me to put large powers in the Bill in Committee in order to check the inefficiency of a great deal of vaccination that goes on now. Well, Sir, I say that any recommendation coming from the hon. Gentleman—knowing, as I do, how large his experience is—will be received by me with the greatest consideration, and in that respect I shall be glad to reconsider the position, and anything which, he may suggest. But, at the same time, I am bound to point out that there are very considerable difficulties in connection with this proposal, some of which, I think, may have escaped his attention. In the first place, it is not the practice in Scotland to-day as he suggests, and the whole object I had in view in promoting this Measure was to assimilate the practice as much as possible in England to that of Scotland. Then, again, I do not understand why a burden should be imposed upon the rates which has hitherto been, I may say even cheerfully, borne by the people themselves. Again, there are practical difficulties. In the first place, the work of all public vaccinators is carried on under the direct regulations and supervision of the Local Government Board, and their work is rigidly inspected in order that it may be ascertained as to whether those regulations have been strictly adhered to. If they have not been, and the work is improperly done, the practitioner guilty of that improper work will be dismissed by the Board. But it is impossible that we should have any such control over the private practitioners in the country, who number no less than 21,000. The work of all those 21,000 private practitioners would have to be inspected. That is a difficulty of 464 a practical character which I am afraid it will be very difficult to get over. Now, Sir, I come next to the points in the Bill, of which the hon. Gentleman was good enough to approve. I do not think I need say anything with regard to the new lymph which it is proposed to use in the future. That appears to have met with general approval on the part of everyone who has considered the subject. On the question of age the hon. Gentleman thinks that the advantages, on the whole, of the age proposed by this Bill, outweigh the objections. I know that some people prefer that the age should be six months, and perhaps I may be permitted to say a word upon that point. My inclination, I admit, in the first instance, was to assimilate the practice in England to the practice in Scotland. In Scotland the ago is six months, but then I found there was this objection to make the ago six months in England. At present the stations in nearly every case—certainly in the cases of the rural districts—are attended only half-yearly, and, consequently, the vaccination of children who happen to attain the present age of three months, at a time when there is no station attendance, is necessarily postponed till next half-year, which takes them up to the ago of nine months, and I am advised that the proportion of these children is very considerable indeed—certainly one-half, and more probably two-thirds of the whole; and, therefore, to have made the ago in the Bill six months would have been to curtail in many cases a very considerable proportion of the time, which, I think, would not have been desirable. The main reasons, of course, for extending the age are the reasons which have been given by hon. Gentlemen on both sides of the House, and in regard to which I entirely concur with them, and upon the whole I think the advantages outweigh the disadvantages which have been pointed out. For that reason I have put that age into the Bill. Then, in regard to the question of stational vaccination, which, I understand, is, upon the whole, approved of by the hon. Gentleman, he urged upon me a point which, I think, is well worthy of consideration, and which I may assure him I have not forgotten. He said, "Do not get rid of the stational 465 vaccination altogether, because there are times and occasions when it will be of the greatest possible use." What I want to point out is this. Stational vaccination is only abandoned in this sense—that it will cease to be compulsory, and children will no longer be required to attend for the purpose of having lymph taken out of their arms and used again for others. But there is nothing in the present Bill, and there is no evidence of any intention on my part to prevent the guardians from still making use of stational vaccination, if they find it to be preferred, whenever they desire. As a matter of fact, we always know that when there is an epidemic of small-pox there is a rush of the population to be vaccinated at once, and we contemplate, especially in populous districts, that stational vaccination will be made use of in the future under circumstances like that, and I shall be only too glad and too ready to listen to any other suggestion upon that point. Now, Sir, I come to the question which I think is the last upon which I shall have to trouble the House—namely, the question of repeated penalties, which, so far as we know, are still the subject of such acute differences of opinion. Upon this point there appears to be a very general misapprehension in the minds of a large section of the public—sometimes in the minds of people who, I think, ought to know better. I have seen it stated, and commonly stated—I do not know whether it has been stated to-night in this House, but I want to take this opportunity of correcting it—that anybody, by paying a trilling fee upon one occasion, can purchase exemption from the operation of the Bill. That is quite a mistake. Whether the fine to be imposed is going to be trumpery or not is a matter which rests entirely with the magistrates, over whom, of course, I have no control whatever; but, as a matter of fact, all the defaulters will be liable under this Bill to two different prosecutions. Under two clauses of the Act of 1867 the same state of things exists. Under both of those clauses defaulters can be penalised. The first of those is Section 79, under which a parent who neglects to vaccinate his child will be liable to a penalty, and the second is 466 Section 31. Under Section 31, if a registrar or an officer of the Board of Guardians informs a magistrate that he has reason to believe that a child in the union under 14 years of age has not been successfully vaccinated, the magistrate may summon the parent of the child then and there, and he can make an order directing the vaccination of the child within a certain time. If that is not done, then the parent becomes liable to another prosecution and penalty, and this kind of order, under the present law, may be repeated again and again ad infinitum. Defaulters, therefore, under the Bill will be liable to two prosecutions and two penalties for neglecting vaccination, but, under the Bill as proposed, the repetition of these orders, which can be made without limitation at the present time, will be prohibited in the future. That is the exact position under the Bill, which I thought perhaps it was desirable to explain. I am quite aware that in some quarters, at all events—although that aspect of the Bill has not been criticised here to-night, but from a great variety of different quarters very much information has reached me—this proposal in the bill repealing the imposition of repeated penalties has met with a great amount of disapproval, and I am prepared to make this admission: that if the system of repeated penalties has been effectual in securing the vaccination of children whose parents object to it, then I admit that there would be a great deal to be said for its retention. But I am afraid there are a great deal too many records which show that, so far from succeeding, the effect of that system of repented penalties has been rather of an opposite character. I do not think it can be denied by anyone who considers this question dispassionately that one result, at all events, of this repetition of penaltes has been to make martyrs of a number of—certainly I think very misguided, but at the same time very well-meaning—people, and to excite an amount of antagonism and direct hostility to the whole system of vaccination which I do not think myself would over have existed without that incentive. Then, again, whenever this question of repeated penalties has been the subject of any public inquiry by any responsible body 467 they have always been, unanimous in support of its repeal. There was a Committee which sat in the year 1871. They reported unanimously in that sense, although Parliament has never thought fit, until now, to give effect to their recommendation. Then again, there was a Royal Commission which has recently reported, and so strongly were they of that opinion that no less than six years ago they took an opportunity of making an ad interim report in which they made a unanimous recommendation for its repeal. In addition to that there is a letter very well known which was addressed to the Board of Guardians—I forget how many years ago, I think it was in 1872—but it made recommendations to the Board of Guardians, and this letter has been repeated over and over again since then, and praccally in the same direction. Well, Sir, it seems to me that it would have required very strong and convincing reasons to justify me in setting aside this weight of authority upon this particular point, and I do not find any such reasons whatever in any arguments which have been addressed to me hitherto. If it was simply a question as to whether vaccination should be enforced or not, and if it was certain that the retention of the repealed penalties would ensure this enforced vaccination, then I should not have a doubt myself on the subject, and I should have retained the system of repeated penalties; but this cannot be so, and it certainly is not borne out by our experience; and what we have now to consider, in my opinion, is whither or not the system of repeated penalties would or would not be most likely to bring about that antagonism to the principle of vaccination of which I have already spoken. This is a question which I admit is fairly open to argument, but, giving the subject the best consideration in my power, I have come to the conclusion that the balance of argument, and certainly the balance of authority, is in favour of the proposal which I have made, and therefore. I have inserted it in the Bill. Now, Sir, I come to the question which is raised by my Friend the Member for Ilkeston. Now he, on the one hand, complains because the Bill does not go much farther 468 than this, and does not accept the other recommendation which was made by the Royal Commission. The Royal Commission, he says, has killed compulsion. He says you cannot compel vaccination, because one-fifth of the representative authorities in the country are entirely opposed to compulsory vaccination. The local authorities would not carry out the principle, and, therefore, my hon. Friend says you had better accept the position and acknowledge that you are much better without compulsion. Well, Sir, in the first place, I would say with respect to this that I am not altogether without hope, and very considerable hope, that with an improved and amended Bill like that which I have endeavoured to lay before the House, containing proposals which will entirely alter the present system—which removes many grievous objections to vaccination, and which gives great facilities for vaccination—much of the opposition to vaccination may, and very probably will, die out in the future, and that we shall find that the local authorities throughout the country are prepared to enforce it much more readily than they have been in the past. But there are two other reasons why I do not like to accept this proposal. In the great majority of cases where people neglect vaccination, it arises from indolence, from carelessness, and from other causes on the part of people, rather than from any rooted opposition to the practice. ["No, no!" from the Opposition.] Hon. Gentlemen opposite say "No, no!" but I have taken great pains to obtain all the information which is possible, and which is in my power, upon the subject, and I believe I am stating a fact which is absolutely accurate. All such cases as those I have mentioned will be met and provided for by the Bill as it stands at present. There is another reason—and I will be perfectly frank—there is an active and powerful body of men at the present moment who desire the total repeal of the vaccination laws, and I am glad to see that I am borne out in that statement by the limited number of Members on the other side of the House. I repeat, there is an active and powerful body of men who desire the total repeal of the vaccination laws, and who are zealously working to procure their abolition 469 altogether. Well, Sir, with their powerful organisation, with their zealous and restless energy, nothing in the world would be simpler than to arrange for conscientious objections to be presented by the thousand. But what I am afraid of is this: if I accepted the proposition of the hon. Member for Ilkestion, we should see in a very short time, in a number of large districts throughout the country, that vaccination would be done away with altogether. I have no wish whatever to raise any argumentative contentions, but I must have different arguments to these which have been advanced in favour of this proposition which have been submitted to me as yet, before they could make a convert of me upon this particular point; and I, for one, should not be disposed to encourage, in any way what's ever, vaccination becoming a dead better. I am as strongly convinced as any Member of this House that vaccination is an absolute necessity, and is to the best interest of the community as a whole, and I think it would be nothing short of a national calamity if it fell into anything like general disuse. So long as I am responsible for the conduct of the vaccination laws nothing will induce me to sanction, or to suffer, anything of the kind. What is the best mode of enforcing then may, I admit, remain to be proved in the future. I honestly believe myself that the course I have adopted is the right one. If it fails, which I do not and will not and cannot believe. I should not hesitate for a moment, again and again if it were necessary, to ask for any additional powers that were needed to enforce vaccination throughout the country. It seems to me I have same right to hope, some ground for believing, that no such powers will be required. In the Bill which the Government has introduced we have done our utmost to remove, on the one had, every legitimate grievance and every possible objection that can be and has hitherto been raised: while, on the other hand, we have sought to provide, and especially for the poorer classes of the country—and I absolutely deny that this is a question between the rich and the poor—facilities with regard to vaccination which have never been enjoyed before. It must also be remembered that when this Bill becomes 470 law we shall have assimilated the practice in England as nearly as possible to the practice in Scotland, where vaccination has never been at any there the difficulty that it has sometimes been with us. Why am I to suppose that under these circumstances, when the people in England and Wales have been placed in a position of similar advantage to the people of Scotland, that they are going to be less reasonable, or less sensible, than their fellow countrymen and friends on the other side of the Border? It would be an insult to their intelligence if I were to do so, and until the contrary is proved I shall decline altogether to believe it. Sir, I ask the sanction of Parliament to this Bill, because I am persuaded that it is conceived in the best interests of the whole population of the country, and especially of its poorer classes; and it is in that spirit that I commend it to the judgment of the House of Commons, and I earnestly hope that the House of Commons will allow it to be read a second time this afternoon.
§ MR. E. H. PICKERSGILL (Bethnal Green, S.W.)
The right hon. Gentleman who has just sat down, has, in the course of his speech, made an announcement of the first importance to which the attention of the House, and of the county, ought to be at once emplatically called. The right hon. Gentleman has told the House that, by the rule-making power which he possesses under the existing Act, it is his intention, as part of the effect of this Bill, to authorise in each district the vaccination officer to commence prosecutions without the authority of the local guardians. Sir, I think I am not exaggeration when I say that the country will regard that announcement with amazement. Speaking for myself, that announcement opens, to my mind, a prospect which I cannot contemplate without serious alarm. What does it mean? Hon. Gentleman who laught do not appear to me to appreciate the gravity of the situation. I will endeavour to enlighten them. What does it mean? It means that in Leicester, and in Mile End—respecting which my hon. Friend spoke so well a little while ago—and in 471 many other parts of the country which I might mention, where the local feeling is absolutely opposed to vaccination, and where that local feeling is at the present moment represented by the guardians, and where the guardians, as I think, very properly give effect to that local feeling—by the fiat of the right hon. Gentleman an officer of the guardians is to intervene, not only without the authority of the guardians, but, in spite of the express instructions of the guardians, is to commence prosecutions. Sir, I am glad that that announcement has 'been made before the Second Reading of the Bill. Voting now for the second reading of this Bill will mean something very different from what voting for the second reading of the Bill would have meant before the announcement was made by the right hon. Gentleman. A vote now—and let every hon. Member clearly understand this—in support of the second reading of this Bill will mean that the hon. Member who gives it endorses the announcement of the policy which the right hon. Gentleman has made. The cheers are not so loud now from the other side, I think, as they were a moment ago. Very well, then. I will appeal from the House to the country, and I certainly think the answer of the country will be very different from that which hon. Gentlemen opposite seem to anticipate. Now, Sir, this announcement emphasises the insidious character of one clause of this Bill, Clause 2, which, under the plausible pretext of making provision against repeated penalties, really asks the House of Commons to set its seal, and its sanction, upon prosecuting parents who have conscientious objections to the vaccination of their children. It is perfectly true that if you pass that clause you are preventing a parent being prosecuted more than twice, but you are at this time of day, giving the seal of your approval to the prosecution twice over of a parent who has conscientious objections to vaccination. The effect of it will be really to sharpen that weapon of oppression which has become a little dull of late. May I turn for a moment to the comic side of this clause? The vaccination law is professedly a law of public health, and the usual type of punishment for a violation of a law of public health is, in the first place, a certain penalty for 472 the original offence, and then an additional penalty for every day during which the offence is continued; or, in other words, obstinacy in resisting the law is regarded as a serious aggravation of the original offence. But this Bill is contrary to every principle of sound criminal jurisprudence, and contrary, in particular, to the practice which is now becoming happily established in our criminal courts. This Bill strikes down the first offender, while it allows the habitual offender to go free and triumphant. It does seem to me that that is a most ridiculous result. Now, may I refer for a moment to Clause 1, Sub-section 3, of this Bill? As I read this Bill a condition precedent to liability to prosecution will be the offer, and the refusal of vaccination from glycerinated calf lymph. This is a penal statute, and with a penal statute everything ought to be definite and precise; but here I would submit that it is really trifling with Parliament to ask it to introduce into a penal Statute such a term as "glycerinated calf lymph" without any scientific definition, and, indeed, without any definition at all of the nature of glycerinated calf lymph. There is not a word as to the ingredients of the lymph or as to the preparation of it. I would ask the right hon. Gentleman the Attorney General what is the meaning of glycerinated calf lymph within the meaning of the Bill. Nobody heard of it until six or seven years ago, and six or seven years hence glycerinated calf lymph will follow all its predecessors of empirical compounds into the limbo of oblivion. As a climax of folly, the right hon. Gentleman, as he told us the other day, has made arrangements with the Medical Institute of Preventive Medicine for a supply of this calf lymph. [The PRESIDENT of the LOCAL GOVERNMENT BOARD: I said nothing of the kind.] The right hon. Gentleman said he had made arrangements with the authorities of the Medical Institute of Preventive Medicine for the supply—[The PRESIDENT of the LOCAL GOVERNMENT BOARD: No, I did not. I said I had made arrangements to obtain the necessary premises for its supply.] Are we to under stand that there are to be simply relations as between landlord and tenant between the Government and the Institute of Preventive Medicine? There is 473 something far more than such relations between these two bodies. Really, I presume the Medical Institute of Preventive Medicine is to supply this lymph, or is to be in some way responsible for it. That certainly is an arrangement which I do not like. If there is one body which is unpopular and distrusted by the people of London it is the Medical Institute of Preventive Medicine, and yet this Institute is to take some part—what part the right hon. Gentleman will not explain—in regard to the supply of this lymph. I think that is an arrangement which will not generally commend itself. Now, Sir, the right hon. Gentleman alluded to the existence of a body of men in this country—with whom I may say I have no connection—who he said were seeking to repeal entirely our vaccination laws. Sir, if there is one thing which will give additional strength to the efforts of these men it will be the passing of this Bill, which the right hon. Gentleman has put before the country, because after all the proposal to repeal the penalties is only a compromise. It is a compromise, I say, and must be taken as such. But if that compromise is not accepted, then I say that the body to which the right hon. Gentleman refers will receive a large number of adherents, because others who do not at present belong to take the offensive and to carry the war into the enemy's country, and the question will be fought as to whether it is right that public money should be lavishly spent for a purpose, the usefulness of which has never been proved, and which at every stage of its history has been put forth on the community under cover of promises, which in all cases have been broken. Before I sit down I want to refer to some observations made by two distinguished medical gentlemen, one speaking from this side of the House and the other form the opposite side. I do not think the medical profession will thank either the hon. Member for Ilkeston Division or the hon. Baronet the Member for the Universities of Edinburgh, and St. Andrews for the references made to the members of their own profession. The hon. Member for Ilkeston 474 charged the members of his own profession with making sham operation, with pretending to vaccinate children, and actually giving certificates under their hand, if not under their seals, that the children had been vaccinated, when, as a matter of fact, it was all a sham. Does not that open out an alarming prospect? It is admitted on both sides that it is common ground that vaccination is a dedicate operation, the safety of which depends entirely upon the conscientious discharge of his duties by the medical man operating. And yet we are told by a very distinguished member of the profession that there are many men who carry out sham operations in order to support the system. He said such cases disturbed the statistics—one or two cases would not disturb the statistics—and I say it is a very serious thing for the hon. Member to bring such a charge against the members of his own profession. The hon. Baronet the Member for the Universities said that he stood aghast at the risks which they ran in vaccinating in the days of his youth. Yes, Sir, in the days of the youth of the hon. Baronet vaccination was supported in this House by just the same arguments as now, and the statement of anyone on these Benches who said in those days that we were running great risks would be denied then, as I presume it would be denied now. These statements made by such distinguished members of the profession will, I think, be taken to heart by the country, and they will make the country all the more determined that the system of compulsory vaccination shall no longer be continued.
§ *Mr. C. J. MONK (Gloucester)
The hon. Member who moved the rejection of this Bill made two statements regarding my constituency to which I desire to refer. The hon. Gentleman stated that the city of Gloucester was supplied with water from the Severn at a point where, owing to the tidal nature of the river, the sewerage of the city passed. He also stated that city of Gloucester was in a very bad state, and that the outbreak of small-pox was mainly due to the unsanitary state of the city. I most distinctly deny both these statements. For many years past Gloucester has 475 not taken any supply of water from the Severn.
§ *MR. THOMAS BAYLEY
Do I understand the hon. Member to say that no water has been taken from the Severn?
§ *MR. MONK
I was just coming to the point to which the hon. Member refers. From my boyhood, 50 or 60 years ago, water has been obtained from two reservoirs, one at Robin's Wood Hill and the other at Witcombe. Some years ago, I think not later than 1891, during a draught in the summer, water was taken from the Seven, in order to supplement the supply from the reservoirs. I must tell the hon. Member and the House that, for the last seven or eight years, no water has been taken from the Severn for drinking purposes, and at the present moment there is an admirable supply in the city. As the horn Member has stated, the new waterworks were opened in July, 1896, and there is now, I believe, no city in England better supplied with water, and I can tell the House, on the authority, not only of Dr. Coupland, but also of Mr. Read, the city surveyor, that the drains of the city will compare favourably with those of any other city or town in England. The outbreak of small-pox in Gloucester, which caused the illness of not less than 2,000 out of 40,000 inhabitants, was in no way caused by the insanitary state of the city. The mortality was certainly very great, but of that mortality less than 10 per cent. were of the vaccinated or re-vaccinated class, whereas 40.8 per cent. died among the unvaccinated class. But the hon. Member stated that 190 persons who died had been vaccinated or re-vaccinated. Now I may state that, of that number, 86 were vaccinated within a fortnight of the small-pox attacking them, and before the effects of the vaccine could have any effect upon them. I apologise to the House for making this explanation, but I did it in justice to my constituents.
§ Debate adjourned till Monday.