§ Dr. HILLIERI desire to take this opportunity, more particularly as the President of the Local Government Board is present, to invite the attention of the House to the public health administration of the Board over which the right hon. Gentleman so ably presides. I may say at the outset that I have every admiration for the public health administration of that Department as a whole, and I know that there is no branch of his work in which the right hon. Gentleman takes a keener interest than in that of public health. I regret, however, to feel it my duty to call attention to what I venture to regard as the very unfortunate prejudice which appears to influence a certain branch of his public health administration. The subject to which I refer is that of vaccination and to the fact that exemptions from vaccination are growing at an alarming rate throughout the country. I have during the past few weeks addressed several somewhat searching questions to the right hon. Gentleman, and I take this opportunity of thanking him for the courtesy and completeness with which he has replied to these questions on this subject. Among them I received a reply with regard to the present number of exemptions from vaccination in the country. He told us that during the first half of last year there were 456,533 births and of those 110,851 had received exemption certificates. That amounts to nearly 25 per cent. of the newly born. I am aware that there are still those who believe that the world is flat, and it is possible, such is the variety of views held by Members of this House, that there are Members who entertain the opinion that vaccination is of no value as 545 a preventative or protection against smallpox. Indications have been manifested during the last few weeks which lead me to the conclusion that there are certainly some Members who hold that view. I do not propose to take up the time of the House by labouring that point, but I should like to call attention briefly to the small epidemic we have recently had in London. According to a written reply given me on 14th March, published in the OFFICIAL REPORT of that date, there had then been fifty-four cases; forty-one were vaccinated, of whom two died, and thirteen unvaccinated, of whom six died. That is, there were nearly 50 per cent. of fatal cases among the unvaccinated. To show that that is not a singular occurrence or a mere accident, I will quote a few lines with regard to the 10,403 cases treated in the Metropolitan Asylums Board Hospital at Homerton from 1873 to 1884. The deaths among the vaccinated were 10.5 per cent., and among the unvaccinated 43.4 per cent. In the epidemics investigated by the Royal Commission on Vaccination in the three towns of Dewsbury, Leicester, and Gloucester, where vaccination had been neglected, we find that, under ten years of age, among seventy-two vaccinated children attacked two died, or 2.7 per cent., whereas among 061 unvaccinated children attacked, 350 died, or 37.3 per cent.
When I remind hon. Members that during the eighteenth century it was estimated that in every twenty-five years there were 15,000,000 deaths from smallpox, and when I point out the tremendous difference in the mortality among vaccinated and unvaccinated cases respectively, I think the House will admit that the question is one of profound national importance. It has been my lot to see small-pox come upon an unvaccinated community. I spent many of the earlier years of my life in South Africa, and one of my first experiences was an epidemic of small-pox among the native races, before vaccination had been introduced. I have also seen yearly in that country hundreds of natives come down from the interior pitted with small-pox, disfigured until there was scarcely a spot the size of a thumb-nail on their face which was not marked by the ravages of this disease. I cannot help recalling what occurred with this epidemic of which I was a witness. We had every facility for isolation, and we adopted methods of isolation. No doubt that was instrumental to a very large extent in checking the 546 course of this disease. But the disease was never stopped or stamped out in any quarter until we had got the whole of the native population of that particular locality vaccinated. There was one particularly interesting case, and that was the case of the Mahomedan races dwelling on the Cape Peninsula. The small-pox epidemic spread amongst them, and they died in great numbers. On religious grounds—they were conscientious objectors—they were not vaccinated. They believed it was an insult to the Deity to resort to such very human and artificial a device as vaccination. On this ground they refused to be vaccinated. But before that epidemic had run its course, when they saw the protective value of vaccination amongst the natives who were vaccinated, and among the few Mahomedans who were gradually persuaded into being vaccinated, Mahomedans came to the public vaccinators and prayed that they also might be afforded this protection, and so were vaccinated.
I will give now one more experience later when I was on a scientific errand to Berlin. I had one or two interviews with Count von Porsodowski, who was then Minister in the German Empire corresponding to the office of our Home Secretary. He was very interested in the public health legislation and practice of this country. He remarked to me: "You have very weak laws with regard to vaccination in your country." I replied: "Yes, I fear we have." He responded: "To us Germans it is a matter of great surprise that you gave the world vaccination and yet you keep small-pox." [An HON. MEMBER: "HOW much?"] How much? 2,500 deaths in 1902. But I will come to that presently. What are the German statutes and what has been the German practice in the matter of this disease? Germany has a law which enjoins vaccination and re-vaccination, and they have practically stamped out small-pox in their country. I should like, however, briefly to refer to figures taken over a period of ten years—and I might quite well extend the comparison further—as to the deaths from small-pox in the German Empire and in the United Kingdom. I have here the total deaths from small-pox in the German Empire for the years 1808–1908, inclusive; that is a period of ten years. The population of the German Empire in 1008 was over 62,000,000. During the whole of those ten years—and I might go back another five or ten years—deaths from small-pox out of that enormous 547 population never in any one of those years reached the number of 100. Actually the highest number was sixty-five in the year 1008. What was our experience during the same decade? We had during the same decade in different years 600, 700 and 800 deaths out of a population of 44,000,000. In 1902 there were 2,545 deaths from small-pox in this country. I confess that, until I came to study the figures I was not aware of our national disgrace in this matter. [An HON. MEMBER: "That was before the exemptions took place."] I am dealing with the broader question first of all, although, as a matter of fact, the hon. Member is not quite accurate, the exemptions began in 1898, under the Conscientious Objectors Act, so he is not quite accurate. I will give one more final piece of evidence with regard to the position of affairs in Germany, because it was obtained by the Local Government Board for their own information and by one of their own officials, Dr. Bruce Law. In his report he says in Germany practically no steps are taken for providing hospitals such as we have here for the accommodation of smallpox patients. In London there are hospitals with beds capable of containing 2,000 or 3,000 patients. In the whole of Berlin they rely upon a dozen beds in a pavilion off one of the general hospitals, because they rely with absolute confidence upon their measures of vaccination and re-vaccination.
I do not think I need labour this point any further, the effect of vaccination and re-vaccination, as a prevention of smallpox is that it reduces small-pox almost to a negligible quantity. I think that is sufficiently demonstrated by what I have adduced to the satisfaction of any ordinary rational being. Why is it then that such a prejudice has arisen, as I admit has risen in this country against it? There was a period when arm-to-arm vaccination was in vogue, a certain number of cases of septic arms arose, which did cause disease and even a few deaths, and which in certain quarters gave rise to a certain amount of prejudice against the whole practice; but that period has gone by. We have learned our lesson in these things, and to-day the application of calf-lymph supplied by the Local Government Board is accompanied with a minimum of risk, which is infinitesimal when compared with the risk of small-pox which anunvaccinated person runs in this country, and still more if he goes abroad, along the Mediterranean 548 or to any places on the African coast. This is a national question in which we are all deeply interested, and I am not endeavouring to make any party capital out of it. It is a national question in which we are all interested, and I cannot help looking forward to the national welfare in this country with some anxiety. It may be argued that, with all our modern appliances for the isolation of infectious diseases, and all our public health and sanitary developments, we can afford to run the risk of allowing the population to go unvaccinated. I have thought about this question a great deal, and I have had much experience in vaccinated and un-vaccinated communities, and I recognise that this is a risk which we cannot afford to run. Even supposing we succeed for a time in practically having no small-pox at all, it is always liable to be imported. Cases may arise amongst adolescents or adults, and if you could ensure the cases being taken forthwith to some place and isolated then there would be a strong primâ facie case for the other view which is held upon this question. But you cannot rely on your present system. Mistakes in diagnosis have arisen, and they always will arise. I can assure hon. Members that it is not such a simple thing at the first blush to determine whether a case is small-pox or chicken-pox. In a great many cases of this disease amongst the native races it is almost impossible to diagnose them, although it is not so difficult amongst the white races. Many of our doctors have had very few opportunities of ever seeing small-pox, and, therefore, they are not too familiar with it. You cannot rely upon the fact that no mistakes will be made, and you cannot rely upon this disease being brought to the notice of the health authorities the moment it arises. The danger is very much increased in this way, because you now have 25 per cent. of your children unvaccinated, and that is an under-estimate rather than an over-estimate. You have an increasing number of unvaccinated children in this country. The time will come when these infants will become adolescents and adults, and the danger of an epidemic amongst the community will be greater in that case than when it occurs in the case of children taken ill at home. When an adolescent or an adult going to his daily work contracts this disease there is a good chance of his continuing at his work and infecting, perhaps, another twelve or twenty people before the disease is noticed.
549 What is the remedy which we can, as reasonable and moderate politicians and Members of this House, with some sense of public responsibility, urge upon the Local Government Board? I am not going to propose the re-enactment of compulsory vaccination. That may or may not be expedient, and the time may come when, through a national disaster, we may be compelled to resort to it again. I sincerely hope that time will not come. As a matter of practical politics I do not suggest the re-enactment of compulsory vaccination. What I ask is are we, under the existing conditions and under the existing law doing our best in the matter. Compulsory vaccination is practically gone, but it should be borne in mind that the State still interferes in this matter, and still keeps up a staff of vaccination officers and public vaccinators, supplies lymph, and sends certain forms notifying parents that their children if not vaccinated may be vaccinated. It amounts to little more than that, and that is the point on which I desire to criticise the administration of this portion of our Public Health administration at the present time. After the registration of a child, the parent is furnished with what is known as Certificate A, calling his attention to the fact that the child must either be vaccinated and a certificate furnished to that effect, or a certificate of conscientious objection furnished. It is with regard to these forms I desire to enter a respectful protest. Take the last form which is sent to the child's parent. It is not long, and I will read it:—
I hereby give you notice that on a certain day your child will be four months old, and that, unless within seven days from that date I shall have received from you or from the Public Vaccinator a certificate of the successful vaccination of the said child, or a statutory declaration made under Section I of the Vaccination Act, 1907, within four months of the birth of the child or some other legal excuse for the non-vaccination of the child, it will be my duty to notify the case to the Public Vaccinator, who will then in due course visit the child's home and offer to vaccinate the child.And so on. This is going a bit too far. We have had the conscientious objector going before a magistrate and explaining he has a conscientious objection to vaccination and with some difficulty obtaining a certificate of exemption, now exemption is made not only extremely simple, but is so brought before the notice of the average working-class householder as to lead him to suppose vaccination is really a perfectly superfluous operation, and that it is merely a choice between one bit of paper and another. What happens? 550 The mother of the child turns to her neighbour and says, "What did you do?" She says, "Oh, I got the other certificate, the certificate of exemption." "How is the baby?" "Going strong; he has not had small-pox." "Then I shall follow the same plan." I can quite understand that appealing to the lady householder with several children, but it does not meet the case. There is a danger which is concealed from these people. Hon. Members who are candid cannot deny that this danger still lurks and exists, and will become an increasing danger as you get an increasingly unvaccinatcd community, because it is the vaccinated community which confers a certain degree of protection on the unvaccinatcd community by making the spread of small-pox less liable to occur than it otherwise would be. It is the policy of the State to interfere in this matter. Let our interference be a rational and intelligent one, and to make it that I venture to think—and the opinion is held by a large number of Medical Officers of Health—we should, with the first certificate sent to the parents, also send a circular pointing out in moderate terms the value of vaccination as a means of protection against small-pox, and the fact that after many years of apparent quiesence small-pox has once more appeared in this country, and already cost several lives, advising parents to take advantage of the facilities offered them, and reassuring them further about the dangers with regard to lymph in so far as it is most carefully obtained and provided by the Local Government Board. Some circular in these terms would be converting an irrational into a rational procedure.
§ Mr. GUINNESSI should like to associate myself with the remarks of the last speaker. In my own Constituency, a few years ago, we had an experience not only of the danger to health from an outbreak of small-pox, but of the very great loss and inconvenience caused by the panic which resulted. I cannot help thinking that the Circular sent out by the President of the Local Government Board last January is likely to increase the danger. It is really astonishing that so many as 75 per cent. are still vaccinated. Under the Act of 1898 it was necessary to satisfy the magistrates that there was a really conscientious objection to vaccination, but the present Government, in their second year of office, passed a measure which substituted for that regulation a mere declaration, causing no trouble 551 at all, before the Commissioner of Oaths. The notice requiring vaccination not only suggests facilities for making this declaration, but it actually gives the declaration ready to be filled up. When that declaration is not filled up Form Q is served, and that ultimatum suggests the alternative of a statutory declaration or some other legal form of excuse. I do not know what that means? Yet when the ultimatum is not carried out you get the climax—the public vaccinator will come and offer to vaccinate the child. My own opinion is that an unvaccinated person is a danger not only to himself but to the whole community. We cannot go back on the policy pursued for many years past and abolish the compulsion of vaccination, but I do suggest that the Local Government Board should not encourage people to avoid vaccination. An ordinary parent a few years ago know that vaccination was compulsory: he now naturally thinks that it is no longer compulsory because those who are in a position to judge hold that it is either dangerous or inadvisable. Naturally, it follows, he will avoid the suffering of the child, or the trouble to the mother in looking after it. At the present time the parent has no means of forming a really sound opinion on the matter. The fact remains that the State approves of vaccination—even the two dissentient members of the Royal Commission on Vaccination, 1889, advocated that the State should pay for vaccination. I do not think it is realised at the present time that eleven out of thirteen members of the Royal Commission reported that in their opinion vaccination did diminish the liability to attacks of small-pox, and that while it might not ensure immunity from the disease it would only be contracted in a milder form. I know in my own Constituency certain people think that vaccination propagates certain diseases, but the Royal Commission reported that dangers of that kind were insignificant, and were decreasing. In those days, twenty years ago, calf lymph was not the invariable means of vaccination, and arm-to-arm treatment also took place; at the present time glycerinated calf lymph is the means of vaccination, and, of course, these diseases, not being found in calves, cannot be transferred to human beings by vaccination. I think that is a matter which ought to be put before parents by means of a circular sent out at the same time as the notice requiring vaccination. The same circular ought to contain a few well 552 authenticated brief statistics, such as those brought forward by the Royal Commission, that before vaccination one-twelfth of mankind owed their deaths to small-pox, and before the introduction of this preventive means only one man in fourteen in a large town in England had not had this complaint. It would also be very conclusive, I think, if they showed the experience of other countries, where vaccination has only been made compulsory comparatively recently, and where it is conclusively shown that the decrease of small-pox is not due to improved sanitary conditions. Take the vaccination figures in regard to Prussia, where nine years previous to the Compulsory Vaccination Act of 1874 the number of deaths per million of the population was 790 on an annual average, and in the following nine years the death rate dropped from 790 to only twenty-three, and the last nine years of which I have been able to get the figures it is down to a little over 1 per million. I think a few facts of that kind might easily be compiled by the Local Government Board and put before the people.
§ Mr. GUINNESSThere has been improvement in sanitation, but not in consequence of this Act of 1874 making vaccination compulsory.
§ Mr. PRINGLEIs it in order to discuss the general merits of compulsory vaccination on this Motion?
§ Mr. SPEAKERI do not see any objection to it.
§ Mr. PRINGLEIs not the matter a question of legislation?
§ Mr. SPEAKERThe hon. Member does not suggest that we should go back to it. He is only discussing the advantages of it.
§ Mr. GUINNESSI do not want to go into the question of compulsory vaccination, but I should like to go into the question of the hon. Member for Haggerston (Mr. Chancellor) in regard to the improved sanitation making smallpox less prevalent.
§ Mr. GUINNESSThe drop was from 790 per million in the first nine years to 23 in the second.
§ Mr. GUINNESSIn the following and last nine years it dropped to a little over 1 per cent. At present it is below 1 per cent. In England we have not the same conclusive evidence that they have in Germany, but we must also remember that there are other infectious diseases, such as measles and chicken-pox, chiefly found in children, which ought to have decreased in the same degree as small-pox if the improvement in the case of that disease is due to improved methods of sanitation, because the conditions of infection are entirely alike, and if you do not find a decrease in these other diseases propagated in the same way owing to improved methods of sanitation, you may be pretty well justified in arguing that it is not improved methods of sanitation which have decreased the incidence of small-pox. Medical inquiry has established cycles of small-pox, and I believe the cycle is something over thirty years, and, according to the figures which I have seen, the next epidemic is most likely to take place this ensuing autumn—about October. I think the Government has a great responsibility in this matter, and I would urge upon the right hon. Gentleman no longer to encourage people to avoid vaccination but to take some steps to educate parents before it is too late as to the real advantages of this preventive measure and to take steps to prevent what I think is otherwise an inevitable recurrence of the scourge which, fortunately for us, the present generation have almost forgotten.
§ Mr. BURNSThe hon. Member (Dr. Hillier) paid the Local Government Board a well-deserved compliment for the administration of several branches of public health. I think he might have gone further and said that in no country in the world had there been such a reduction in the general death-rate, such a diminuation of infant mortality, and such an abatement of the scourge of tuberculosis, typhus, typhoid, and many other diseases. I am very much obliged to a medical man paying a compliment to our Department which could be confirmed by facts and figures. But he descended from the general, which was complimentary, to the particular, which was not quite so complimentary. He tried to prove that the eulogy which was due to the Local Government Board in the combating of other diseases was not equally due in the combating of small-pox, but I failed to catch any statistical justification for the distinction between small-pox and the other 554 diseases to which he might properly have referred in his previous remarks. My hon. Friend, with the ingenuity of his distinguished profession, took us to India, South Africa, and the Malay Peninsula.
§ Dr. HILLIERI am sorry if I did not make myself clear. I was referring to native subjects in South Africa and not in India, and to the Malay population of the Cape Peninsula, who are Mahomedans.
§ Mr. BURNSThe hon. Gentleman was giving English application to his observations. He was trying to make our flesh creep by illustrations and by facts and figures which did not and could not apply to the sanitary conditions and social circumstances that prevail in this country at present. I propose very briefly to inform the hon. Member and the House that I decline to allow my flesh to creep in presence of the statement made by the hon. Member. The epidemic which the hon. Gentleman referred to as justifying his criticism of the administration of the Vaccination Acts in this country is after all not the serious thing which one would judge from the general tone of his speech. The facts are these. We have had in the East End of London fifty-eight cases of small-pox. Of these forty-two were vaccinated and two died. There were sixteen unvaccinated and seven died. I decline to deduce anything either for or against vaccination from such figures relating to a small epidemic of this kind. I decline to deduce anything like the panic suggestion underlying but not brought to the surface of the hon. Member's speech to the extent which I would have expected.
§ Mr. BURNSI am going to leave the facts as I have stated them. Until we get complete and final figures in regard to ages, the incidence of the disease, re-vaccinations, and so forth, I think it would be premature and unfair to either side in this controversy to do other than state the simple facts. But if I were not a Minister I would retort on these simple facts that I doubt if we would have had a single death, vaccinated or un-vaccinated, had it not been that there was a mis-diagnosis of a case of small-pox as chicken pox. Those who run may read, and they may deduce from that whatever they like. I am not at all alarmed by the comparison made with Germany. My hon. Friend made a very fair point, if he will allow me to say so, when he referred 555 to the statement of the German who said to him: "Britain has given the world vaccination and kept smallpox." That is a statement of a broad and sweeping kind, hut it has got to be qualified by existing facts. What are the facts? The hon. Member must not go back into history and select the purple patches to support his line of argument. I entertain the respect for figures tempered by fact, which every responsible man ought: to have. Just as in recent years exemptions have gone up from four per cent. to thirty per cent. so deaths from smallpox have declined. I am not going to make the mistake which was made twenty years ago. Twenty years ago a gentleman in a public place pointed grandiloquently to a series of diagrams, which were all wrong, and said to me: "I ask the hon. Member to remember that figures never lie." My retort, and it was effective for the moment, was "No, but liars sometimes figure."
§ Dr. HILLIERI do not know whether the right hon. Gentleman means that to apply to me?
§ Mr. BURNSNo. There is no Member in this House to whom I would be less willing to apply such a remark than to the hon. Member. The occasion referred to was at a meeting of the Statistical Society, and the person in question was a Member of the other House, and my view of his remarks on that particular occasion would have been shared by the hon. Member had he been there. The facts are these. I am right in giving these figures with regard to London. During the time that I have had the honour of being at the Local Government Board the following have been the deaths from smallpox in a city of 4,500,000 inhabitants. 1906 no death. 1907 no death. 1908 no death. 1909 two deaths. 1910 no death. So that in five years there were only two deaths from small-pox in a city of 4,500,000 people. Not even Germany or Berlin can transcend those figures, due to the increasing cleanliness, increasing sobriety and greater attention paid both by the community and individuals to removing all causes of smallpox, and nearly every other disease.
§ Dr. HILLIERMeasles?
§ Mr. BURNSThe hon. Member is trying to get me off the rails of smallpox by talking about measles. Even there I decline to be moved, because in the last six months, when lots of people have been 556 panic-stricken about rat plague, Asiatic plague, small-pox and measles in London, we at the Local Government Board stuck to our job. We have hunted measles like sleuth-hounds. The result is a general decrease. My hon. Friends suggest that we should in some respects alter Form Q.
§ Dr. HILLIERCertificate A.
§ Mr. BURNSBut my hon. Friend said he would not propose any re-enactment of compulsory vaccination. If he is consistent and logical he ought to do so. He said it would not be practical politics. Then he asked, were we doing our best under the existing law to combat smallpox? The figures I have adduced with regard to London—and similar figures can be adduced with regard to England and Wales—have proved that we are. The other suggestion is that we have given a definite indication to parents to exempt themselves by our circular of 28th January, 1910. I would like to meet my hon. Friend, the Member from one of the Suffolk divisions (Mr. Walter Guinness), during the Easter holidays and show him how far we have altered the Form.
§ Mr. GUINNESSI meant to make it clear that you have altered the form that was covered by the circular.
§ Mr. BURNSThese things are never made clear when a Government Department is being attacked. The clearness comes from interpolation, but it does not improve matters so far as the actual facts are concerned. The only thing we have done is this: The form was altered because a certain misapprehension had to be removed, and the circular of 28th January, 1910, was simply to make it clear that the exemption declaration must, under the law as it now is, be made within four months of the birth of the child instead of within four months and seven days. That is the only thing the Government has done recently, and it is the only justification for the criticism to which we have been subjected. With the exception of this form, we have practically adhered to the prescribed forms that were left to us as a heritage of vaccination legislation by the protagonist of prophylactics, the right hon. Member for Wimbledon (Mr. Henry Chaplin), who was my predecessor some years ago in this office. Beyond adopting the form, a simple change under the existing law, nothing has been done, and it is a fact that exemptions have not increased through an alteration of the law. Mortality has diminished. 557 I draw no inference from that fact; but for the first time in the four years since the Act was altered, and not until now, have we heard the policy of the Local Government Board adversely criticised in regard to the administration of this particular code of sanitary laws. After the simple explanation I have given as to the reason why the instruction was altered in January, 1910, and the new Form Q was adapted to the change of the law in 1907, it seems to me that I have nothing further to add except that I cannot accept the hon. Member's suggestion that we should supply on Form A or any other form a few simple and elementary statistics on the subject of vaccination. I have been twenty years a Member of this House, and if there is one subject on which I should be disinclined to quote statistics from any source or any section, it is on the thorny subject of vaccination. Instead of listening to the suggestion of the hon. Gentleman, it seems to me that what we have to do, as the Public Health Department, is to hunt disease of all kinds and descriptions, in every shape and form, and with all the means at our disposal. We have achieved such success as to warrant the compliment, generous and full, which my hon. Friend paid to me and my Department. Instead of diverting my energies in the direction that hon. Members have suggested, they will, perhaps, allow me to go on with the work, devoting to it my brains; and, if it be continued, I believe that it will well deserve at the end of two or three years hence even greater credit than has been given this afternoon. I believe that all this fear and panic, all this talk about plague and small-pox is due to misconception and misapprehension of social facts. These diseases are in a very different position from what they were ten, twenty, thirty, or forty years ago, and it is a creditable and a happy circumstance that I, as Minister of Health for England and Wales, am enabled to state that in regard to the administration of public health no other country is comparable to ours, and I am pleased to have heard such hearty recognition of our efforts from the different speakers this afternoon.
§ Mr. H. W. FORSTERThe right hon. Gentleman said this was the first time the administration of the Vaccination Acts had been criticised. If he never suffers from criticism more than he has to-day he has not much to complain of. The right 558 hon. Gentleman himself has acknowledged the fairness with which the subject was brought before the House. I am reluctant to point out that the right hon. Gentleman has not answered the simple question put to him by my two hon. Friends as to whether he would take steps, the very inoffensive steps that they urged upon him, with a view to influencing the opinion of parents as to the desirability of having their children vaccinated. The right hon. Gentleman commented on statements they had made and figures they had quoted, and referred to every portion of their speeches except that portion, which invited him to take some slight step in the direction suggested. I hope we may yet in this Debate have an assurance from the right hon. Gentleman that he is going to carry out the wishes of my two hon. Friends. In criticising the speech of my hon. Friend who brought this matter forward the right hon. Gentleman says that he failed to produce any statistical evidence of failure, that is the failure of his administration. The right hon. Gentle-man and the House should bear in mind that the steps in the direction of making exemption orders have been taken so lately in the administration of the Local Government Board by the right hon. Gentleman himself that there has been no time to procure any statistical evidence. Therefore, I think the right hon. Gentleman cannot fairly blame my hon. Friend for not having supported his case by statistical evidence drawn from the last few years. My hon. Friend referred to the growth in exemption from vaccination which has taken place within the last few years. It is owing to that growth of exemption that the fears entertained by my hon. Friend are grounded, and, as I think, well grounded. Let me remind the right hon. Gentleman he did not remind the House of the great growth in exemption which has taken place within the last five years.
§ Mr. BURNSOh, yes, I said that in the period of mortality from small-pox referred to that exemption had grown from four to thirty per cent.
§ Mr. H. W. FORSTERThe right hon. Gentleman, only a few days ago, in the House, admitted that in some localities the exemptions exceeded fifty per cent. That is the danger with which we are confronted when we consider whether or not the administration of the right hon. Gentleman is everything that could be desired in the matter of vaccination. The 559 hon. Member for Haggerston (Mr. Chancellor) suggested that the great decrease in the number of deaths from small-pox was, at any rate, very largely due to improved sanitation. He asked my hon. Friend if he would take German figures for the year before 1874 and the year after 1874 so as to show if my hon. Friend's contention was well-founded—namely, that the great improvement in this matter was due to the vaccination law which the Prussian Government had passed. I happen to have figures which will, I hope, make the point clear to the hon. Gentleman who asked for them. They are the deaths from small-pox per million of the population before 1874 for nine years.
§ Mr. FORSTERI will give several years. The year before 1874 there were 95 deaths per million; the year before that, 357; the year before that, 2,624; the year before that, 2,432; and so on. There were 95 deaths per million the year before, 36 the year after; 31 the year after that; then 3, 7, 13, 26, 36, 20, 14, 14, 5, 5, 3, 5, 1, 1, 3, 4, 3, 8. I think these figures bear not unfavourable comparison with the excellent figures which the right hon. Gentleman was able to quote in regard to London itself. The hon. Member will see that at any rate, so far as the figures go, they bear out the contention of my hon. Friend, that a vast improvement took place after the passage of the Prussian Law.
Mr. CHANCELLORThe hon. Member said nothing about the improvement from over 2,000 down to 95 which took place before.
§ Mr. CHARLES DUNCANThe hon. Member pointed out that the year before the Act was put into operation the figures had fallen from over 2,000 to 95. He has not accounted for that at all.
§ Mr. FORSTERThat is a drop in one year. Even the most embittered partisan of anti-vaccination must admit that visitations of small-pox vary in their intensity. Undoubtedly, some are far more serious in their effects than others, and it is obviously impossible to judge merely from the figures alone as to the nature of a particular visitation. What I was offering to the hon. Gentleman was statistical proof, for which he asked, that my hon. Friend's contention was well founded. 560 My hon. Friend quoted some figures which went far to show the value of vaccination and re-vaccination in the case of a serious outbreak of small-pox. I wish to quote one other figure of great significance, which I think must convince anybody who approaches the consideration of this question with an impartial mind of the value of vaccination and re-vaccination. A special committee was appointed by the Metropolitan Asylums Board, who control the Small-pox Hospitals of London, to collect statistics relating to the great small-pox epidemic of 1870 and 1872. This is what they reported:—
The necessity of re-vaccination when the protective power of primary vaccination has to a large extent passed away, cannot be too strongly urged. No greater argument to prove the efficacy of this precantion could he adduced titan the fact that out of upwards of 14,800 cases received into the hospitals, only four well authenticated cases were treated in which re-vaccination had been properly performed, and those were light cases.Out of nearly 15,000 cases there were only four cases of people who had been properly re-vaccinated. I could quote other figures to bear out the contention, which can only be denied with difficulty, that re-vaccination is of the greatest possible value. In face of figures such as these, it is perfectly idle for any hon. Member to get up in this House and to say that there is no real value in vaccination and re-vaccination. The point which I wish to make becomes clear from the figures that the President of the Local Government Board gave to the House only a few months ago in connection with the recent epidemic in London, which I hope has now come to an end. The figures that the right hon. Gentleman gave—and I acknowledge the fairness with which he gave them—showed that in cases of smallpox where re-vaccination had taken place the deaths were roughly 1 in 20, and where no re-vaccination had taken place the deaths were nearly 1 in 2.These are very significant figures; they prove the danger of neglecting the great safeguard of vaccination. The right hon. Gentleman told us that there were 40 diagnoses. But 40 diagnoses might presage a most serious outbreak, instead of an epidemic of a moderate character. The risk is there all the time, and it is to obviate that risk that we invite the right hon. Gentleman to issue with Certificate A a notice to parents directing their attention to the true value of vaccination as a method of prevention of small-pox. Can we be accused of asking anything unreasonable when we invite the right hon. Gentleman to take that step? We are not asking him 561 to strain the law, or go back from the position which has been adopted by successive Presidents of the Local Government Board We are not asking him to do anything further than this: to give to poor and uneducated parents some meed of advice as to the safety to be found in vaccination. I remember perfectly well, just as many other Members of the House do, the beginning, or at any rate the comparatively early stages, of the movement against vaccination. I have myself seen some of the horrors of it. I regret most deeply, as all men who take the slightest interest in this question must, that the practice of arm-to-arm vaccination ever took place. It was owing to the practice of arm-to-arm vaccination that this prejudice was really created, and if pure calf-lymph was used from the beginning there would be no prejudice against vaccination at the present time. We recognise that we cannot go back at any rate, until some great calamity, which calamity, I hope, never will happen, upon the attitude a large body of our people have adopted towards vaccination, but what we can do is to give the people a chance of learning from the lips of the Local Government Board, and from the lips of their officers, that there is value in vaccination, and that is all we ask to have done at the present time. I hope that the right hon. Gentleman may before very long be able to give us assurances that such suggestions will be offered by him.
§ Dr. CHAPPLEI should like to congratulate the hon. Gentleman who introduced this question upon the wisdom, moderation, and scientific precision with which he analysed the facts. Small-pox is bound to die out. It may die by improved sanitation, which sweeps away germs on the one hand and strengthens the individual on the other, or it may die out by acquired immunity in the individual or by acquired immunity in the race. But there can be no doubt whatever of the efficacy of vaccination as a preventative. The facts are proved up to the hilt, and if there was a distribution of germs in this Chamber, or a prospect of such, there is not a Member who knew the facts but would hurry off to be vaccinated. There are some people who are foolhardy enough to run the risk, but it is impossible to go into the facts, which have been accumulated for generations, and to deny the efficiency of vaccination as a preventative against small-pox.
The only question is: Have we arrived at such a degree of sanitation that we can 562 afford to dispense with that preventative? If it is possible to have your slums so clarified, and your drainage so well done, and the general well-being of your community so efficient as to provide a fighting force sufficient to enable you to run the risk of dispensing with an effective remedy such as vaccination, well and good. The problem to-day is not whether vaccination is effective. That matter is removed beyond the region of disputation, and those who examine the facts cannot possibly come to any other conclusion than that vaccination is so effective that it would be the moral duty of every father of a child to see it protected from the danger of small-pox, if that danger was in its vicinity, and that it would be the duty of the State to ignore the claim of the conscientious objector and to say it could not allow an individual to be a centre of infection and of danger of epidemic to the whole community. The facts are so conclusive that the only concession we can make is that if the sanitary conditions are such as to reduce the danger and to ensure the absence of germs, the time will come when we can dispense with vaccination altogether. The question is has that time now arrived? No one can go through the slums of this great city and conclude that that time has arrived. The danger exists to-day in great centres like London and Glasgow, and conditions prevail which would make an epidemic of small-pox an alarming affair. The right hon. Gentleman trusts to sanitary provisions to keep the germs of small-pox out. This is a very difficult task when we have such an enormous congestion of population in our slums, which must become infected centres if the germs of small-pox gain access. We are resting in a fool's paradise in this matter, because by isolation and other favourable conditions there has been no distribution of the germs. If infection started in London it would be the duty of the Local Government Board to insist upon vaccination as a preventive to small-pox. I am prepared for the time to arrive when vaccination can be dispensed with, but the time has not yet arrived when we can allow this important weapon in our attack upon zymotic diseases to be laid aside.