§ LORD LYTTELTON
moved that the House go into Committee on this Bill (according to order); and said that the essential object of the measure was to make vaccination compulsory, and he conceived that that object would be best accomplished by means of registration. It was unnecessary to call their Lordships' attention to the importance of the subject, especially those who had, like himself, been in the habit of attending Boards of Guardians, or to speak of the certainty of vaccination as a preventive of the small-pox, that being a point on which the whole medical profession had arrived at complete unanimity. Some few facts might be stated with regard to it; and he would mention, that for almost all the information he had to lay before their Lordships, having no scientific knowledge of the subject himself, he was indebted to some able and learned persons belonging to the Epidemiological Society—a new society, amongst whose leading members were Sir Benjamin Brodie, Dr. Bright, Dr. Babington, and Dr. Southwood Smith. He believed it might be said that vaccination was fully established about the beginning of the present century, and the way of judging of its effects was to look to the amount of deaths arising from small-pox within certain periods of time. Looking to the last fifty years of the last century, and the first fifty years of the present century, the result was this—that in the first ten years ending 1760 the deaths were 100,000 from small-pox; in the next ten years, 108,000; in the next ten years, 98,000; in the next ten years, 87,000; in the next ten years, 88,000. During the first ten years of the present century the deaths amounted to 64,000; in the next ten years, to 42,000; in the next ten years, to 32,000; in the next ten years, to 23,000; and in the last ten years, to 16,000; showing a diminution from 108,000 down to 16,000, and a continually progressive de- 1003 crease. Single cases were such as that which was reported by Mr. Livett, of Wells, in Somersetshire, from which it appeared that, while since the year 1837 the small-pox had been prevalent in the adjoining districts, there had been no small-pox whatever in a village where vaccination was practised. It was also a remarkable circumstance that, during the forty-eight years that had elapsed since the opening of the Royal Military School at Chelsea, where vaccination was enforced, out of the number of admissions, amounting to 31,705, there was not a single death from small-pox after vaccination. Looking to foreign countries, he was told that in Ahmedebad, in India, where vaccination was introduced in 1817, and where it became general in 1825, the small-pox since then had not been heard of. In Hanover, out of 45,830 deaths in 1847, there were only eight deaths from small-pox; and in Denmark it was said at one time that small-pox had entirely disappeared, from the universal practice of vaccination in that country. Let them compare the state of England and Wales with that, and it would be found that the fatality from small-pox varied according to the practice of vaccination. England and France were the only countries in which vaccination was not directly or indirectly compulsory; he had no figures with respect to the state of France, but the result was not far different from what it was in England. In Hanover, Bavaria, and Sweden, vaccination was rendered compulsory by means of a pecuniary penalty—the means which he proposed to adopt in this country. In Holland and Prussia it was indirectly but most effectively made compulsory; for example, no person would be admitted to a public school, or maintained by public alms, unless he could prove that he had been vaccinated; and in Prussia no man could be married unless he could show that he had been vaccinated. For the purpose of comparing the two systems of compulsion and non-compulsion, he asked their Lordships to look at the two extreme cases. In Ireland, where the greatest ignorance and prejudice might be supposed to prevail on the subject, no less than 58,000 persons had died from small-pox in the ten years ending 1841, and in subsequent years he believed the state of matters was not much improved. That was one extreme. The other occurred in a part of Europe where the material condition of the population was 1004 extremely good—he referred to Lombardy. He found that in Connaught, which might be considered the part of Ireland where vaccination was most likely to be neglected, the number of deaths during the ten years ending 1841 were 60 in 1,000; in Lombardy they were 1½ in 1,000, or 3 deaths in 2,000. These were the two extremes. The average mortality of late years in England and Wales only, excluding Ireland, which would make the statement worse, and excluding Scotland also, regarding which country he believed the same might be said, although there were no returns on the subject—the average number of deaths in England and Wales during eight years was nearly 22 in 1,000; whereas in a long list of countries in which vaccination was compulsory, the deaths ranged from 8 in 1,000 in Saxony, to 1½ in Lombardy, and the average was not quite five. These facts showed that in this country the mortality from small-pox was more than four times as much as it was upon the Continent. He would now ask the House, after the statement of these results, to look at the state of the law in England. The law upon the subject was very short and simple, and was contained in two Acts of Parliament; it was this:—In every union the guardians were empowered to contract with a medical man to vaccinate all children whose parents were not above bringing them to be vaccinated at the public charge. He believed that the Poor Law Board, the guardians, and the medical men employed by them, had done their best to carry this system into effect, but still the result was unfavourable as compared with other countries. That being so, what he proposed was, without disturbing the present system, simply to add the principle of compulsion to it. It would be impossible for a private Member of Parliament to attempt any fundamental alteration in such a system as this. He must take it in the main as he found it, but the alteration he proposed would be a clear gain. He was not aware that any advantage would be lost by the introduction of the principle of compulsion. We should have all the good results we now had under the present system, and an increase of them. It was said that the system now prevailing had been successful; that it was bringing about a progressive improvement, and that all parties concerned were doing their best to make it still more effective. When it was said, how- 1005 ever, that the success of the system under the present law was to some extent progressive, he must point out some serious and important imperfections in it. In the first place, he asked the attention of the House to the exceeding irregularity, uncertainty, and inequality of the system of vaccination at present practised. They were told by the last returns that the number of births registered in England and Wales in the year ending September 29, 1852, was 601,839; and the number vaccinated during that period, under the Vaccination Act, was 397,128; so that, in round numbers, 400,000 were vaccinated by the public machinery in force, leaving only 200,000, or one-third of the whole number, to be treated in the numerous private vaccinations which took place. Now, there were several very important fallacies in that statement. That general result was by no means the result of anything like a uniform system throughout the country. He had before him a detailed statement showing the extent of vaccination in various parts of England in 1851, the result of which showed that there was a great want of uniformity as to vaccination in different parts of the country. It was irregular in point of time; for, wherever small-pox broke out, there was a sort of panic among the people, and then they went to get their children vaccinated. Where the guardians of a union had been compelled to pay a public vaccinator much better than in other places, there the most enormous difference existed in regard to vaccination. As he had stated, the greatest want of uniformity existed in different parts of the country. In towns, where the people had a shorter distance to go to get their children vaccinated, the result, as might be supposed, was more favourable than in the rural districts. For example, in Birmingham, which, as it might be expected, would be found well managed in this as in other sanitary matters, on the total number of births in the year 1851, the vaccinations were 91 per cent; in Leicester they were only 41 per cent, and in Loughborough only 18 per cent. The contrast between the manufacturing and the rural districts was favourable on the side of the former. In Bideford the vaccinations were only 11 per cent upon the births; in West Ashford, in Kent, they were only 22 per cent; and in Winchcomb only 6 per cent. While the general average, however, was lower in the agricultural than in the manufacturing districts, 1006 some contrary instances were found. Thus in Derby the vaccinations were only 42 per cent; while at Watford, which was a rural district, the vaccinations were 126 per cent upon the births, in 1851; that included of course the vaccination of children born in previous years. But in London, and in no less a parish than that of St. James's, Westminster, it was reported that in that year on 973 births only 44 vaccinations took place; while in Wellingborough Union, where there were 800 births in 1851, no vaccination at all was reported. There was another point on which he must lay the very greatest stress, and that was the length beyond the regular period to which the operation of vaccination was frequently postponed. As this was a technical part of the subject, he would beg to read a few passages from the report presented to the Epidemiological Society. The committee who prepared that report upon the subject of the information received from the official documents of the Poor Law Board, said—In examining these important documents, showing the actual progress of vaccination, as carried on under the Act of 1840–41, it is especially necessary to consider the age when the operation ought to be performed. Unless this distinction is kept clearly in view throughout, the most fundamental errors must arise as to the real efficiency of the existing system. It is the opinion of medical authorities that, unless under peculiar and exceptional circumstances, vaccination ought to be performed within four months of birth.One amendment, therefore, proposed to be introduced by his Bill was to bring the number of months within which vaccination must be performed down to three. He took that number upon the suggestion of the Board of Health, to one of the members of which, the noble Earl opposite (the Earl of Shaftesbury), he was much indebted for suggestions in regard to the present Bill. The Report proceeded:—Every day during which vaccination is delayed beyond the right period, leads inevitably to the sacrifice of life. The amount of this sacrifice may be estimated by the following facts:—the deaths from small-pox in 1839 amounted in England to 8,714, of which 202 occurred in the first month after birth; 181 in the second month; 162 in the third; and 456 in the fourth month. So that no fewer than 1,001, or 11 per cent, of the whole died under four months; while 2,235, or 25 per cent, died under one year; and, in 1847, of 4,227 total deaths, 1,074, or 25 per cent, were also under one year. If, as often happens under the present system, vaccination is delayed till the second or third year, or still later, the sacrifice of 1007 life is proportionably increased. It is found, for example, that the deaths under three years constitute from 51 to 57 per cent of the whole mortality from small-pox; while, under five years, the proportion rises to 75 to 80 per cent.….. In the decennial period 1831–41, there perished of small-pox in Ireland 58,006 persons, of whom 45,826, or 79 per cent, were under the age of five years; all of whom, if they had been efficiently vaccinated, might, so far as this disease is concerned, have been now alive.In reference to this subject the Poor Law Commissioners remarked:—Though the number of children vaccinated under one year of age is only 32 per cent upon the number of births, we still think that the relation which the births bear to the number vaccinated is a tolerably correct measure of the efficiency of the arrangements for promoting the object of the Vaccination Extension Act, as, from the communications which we have received from boards of guardians and vaccinators, we learn that vaccination is very frequently deferred till the child attains its second or third year.Upon this statement the Committee thus express themselves:—Although with much reluctance, we deem it essential to enter our decided protest to the principle here assumed. No system of vaccination can be considered otherwise than fundamentally defective under which a large number of children thus remain unprotected to the age of two or three.It must be remembered that attacks of small-pox, even in case of recovery, left the constitution very much impaired, and liable to other diseases. Now out of the total number of 601,839 births for the year ending September 29, 1852, there had been, as he had stated, 397,128 vaccinations by the public officers appointed for that purpose, and 203,039 of those thus vaccinated were above one year, and 194,089 under one year of age. This was a point upon which all the authorities laid the greatest stress, and the Bill therefore proposed that vaccination should be made compulsory within a certain time. This was the general case in favour of this Bill. He proposed to leave out Clause 8, which enacted that all persons coming into the country unvaccinated should be liable to a penalty. He proposed to make it compulsory upon the district registrar, at the time the child's birth was registered, to give notice to the parents and to the guardians of the obligation to have the child vaccinated, because it would be rather hard that poor persons should be liable to a penalty for noncompliance with an Act of which they had not had due notice. The Act only extended to England and Wales. Ireland and Scotland he could not touch, because he was 1008 not sufficiently acquainted with the circumstances of those countries to undertake to legislate for them; but he had great satisfaction in stating that he had had some communication with Members of the Irish Government upon this subject, and they had expressed the greatest anxiety to have the compulsory principle extended to that country. He should, be very happy, if it were found practicable, that the Act should be extended to Ireland and to Scotland. With regard to the importation to this country of non-vaccinated persons, he begged to call the attention of the House to a valuable suggestion which had been made to him on this point. He was told that a very large proportion of non-vaccinated persons, who often spread the infection in English towns, were the inmates of common lodging-houses. Now, there was a system of inspection of these lodging-houses already in operation, and there would be no difficulty, he imagined, in providing that the examination now in force should include an investigation on the subject of vaccination among the inmates, and that all children who should be found unvaccinated should be vaccinated immediately. There was another preventive measure, which he could only recommend to the attention of the Government. It was in regard to the system of the conveyance of patients to and from hospitals to another, and the spread of infection in that way. This, however, he could not undertake to remedy in the Bill, and he must leave it for the consideration of the Government. It had been pressed upon his consideration that what was still wanted was complete system of national vaccination. There now existed a good deal of prejudice among the poor against the present arrangement, which they confounded with pauperism, supposing that, in taking their children to the public vaccinators, they were receiving parish relief. The Poor Law Board had, indeed, issued an order that gratuitous vaccination should in no degree stamp the recipient with the character of a pauper; but, nevertheless, it was a very natural feeling, and if the machinery were separated entirely from that of the Poor Law Board, which had not necessarily any particular knowledge or information on the subject, the system would probably work better. He could not attempt to introduce into this Bill any special provision for seeing it carried into execution, although he was well aware that that formed an imperfection in it. 1009 He could not propose that an inspector of vaccination should be appointed, for it would involve considerable expense, and he did not think that was a point which he, as a private Member of their Lordships' House, should introduce into the Bill; he would, however, recommend it to the attention of the Government. It had been objected that, after all, the Bill would not be compulsory, for that a person might pay the fine which the Act imposed, and leave his child unvaccinated. He believed, however, that the infliction of this pecuniary penalty would be perfectly effectual. The ignorance and prejudice which prevailed on the subject was almost entirely confined to the very lowest of the poor, to whom a fine was very serious: and as it was not a thing which could be visited with any more severe punishment than a pecuniary penalty, that was the only mode by which it could be made compulsory. His own impression was, that sooner than pay the fine, the great majority of parents would have their children vaccinated. Another objection urged against the Bill was, that it was an undue interference with the liberty of the subject. This objection, however, he considered was founded upon an entire misapprehension of the nature of the evil, and of the remedy to be applied. It might very well be argued that parents had no right, even looking to their own children alone, to allow them to take the disease; but the proper object of the Bill was, to prevent persons spreading the infection to others—which he considered in reality a criminal act. The principle of the Bill had, indeed, been already admitted, for it had been made illegal and punishable either to inoculate children, or to expose them so as to be infectious; and leaving them unvaccinated, did, in reality, come under the last head. He came next to the subject of the payment which was made to the medical officers of poor-law unions for vaccinations. He was aware that there was a strong feeling on the part of the medical profession with respect to the inadequacy of the remuneration; but still he felt that this was but a part of the general subject of the remuneration of the union medical officers, and that he could not, therefore, meddle with it. He did, indeed, ask the Poor Law authorities if it would not be possible to fix in the Bill a minimum under which the different boards of guardians should not make any contracts for vaccination; but he was told that no such exception to the general 1010 law, which allowed boards of guardians to make their own contracts for the services of medical men in this matter, could be introduced. Nor, indeed, could he wonder that the Poor Law Board felt a difficulty about interfering with boards of guardians on this subject, when they saw medical men of respectability freely taking these low contracts, and acting on them year after year. He had been told by a noble Friend of his, on the opposite side of the House, that this Bill proposed to punish people for omitting that which they had no facility of doing. He did not, however, believe that that complaint was well founded, because his own experience, and the result of his inquiries at the Poor Law Board, led him believe that no persons who really wished to have their children vaccinated by the public officer, had any difficulty in attaining that object. The noble Lord then, after stating that he proposed to introduce into the Bill numerous amendments, none of which, however, affected its principle, moved that the House should go into Committee upon it.
§ The EARL of SHAFTESBURY
said, that when they considered that the smallpox was not only infectious, but that every person so infected became a centre from which the disease spread, he thought that their Lordships would admit the validity of the grounds on which the demand for a compulsory enactment rested. The voluntary system had been tried for a long time in this country, and had failed; and it was necessary, therefore, to resort to other means in order to guard ourselves from this disorder, which was one of the most frightful scourges that ever afflicted humanity. In order to show how completely the present voluntary system had failed, he would compare, in a few instances taken by chance, the comparative number of births and vaccinations. From inquiries made by the Poor Law Commissioners, it appeared that, at present, of all registered, only three in eight were vaccinated. Of those vaccinated, many most imperfectly—hence small-pox was on the increase. Take, as examples, comparison of births with vaccinations: Bideford—births, 567; vaccinations, 69. Newton Abbott—births, 1,563; vaccinations, 150. Huntingdon—births, 805; vaccinations, 68. St. Neots—births, 671; vaccinations, 17. Carnarvon—births, 929; vaccinations, 125. Bangor and Beaumaris—births, 1,025; vaccinations, 420. Metropolis:—St. James's, Westminster—births, 1,427; vaccinations, 1011 44. Paddington—births, 1,458; vaccinations, 386. Hampstead—births, 286; vaccinations, 93. It was said that people would not accept of vaccination unless small-pox was at the door; that there was a growing neglect of vaccination—that people would not take the trouble to come to the station—vaccination must visit every house: but this omission to have their children vaccinated did not arise to so great an extent as was sometimes supposed from prejudice—though, no doubt, that did prevail in a great many instances—but was chiefly due to indifference or neglect, because directly the small-pox broke out in a district they crowded by hundreds and thousands to have their children vaccinated. The result of this negligence was, that in the year 1835, when small-pox was extensively prevalent, there were 16,000 deaths; and in the two years and a half ending December, 1839, the registered deaths were about 30,000, or about 12,000 annually. Now, if they took the average mortality at one in four of the cases, they would find that these then amounted to nearly 50,000 a year. In Ireland the number of cases varied from 35,000 to 40,000 per annum, because there was there no vaccination at all. The virulence of this disease must, however, be estimated not only by the number of lives destroyed, but also by the sad effects it produced on the human constitution. There was, perhaps, no other disorder which had such injurious effects upon the frame. Where it did not at once destroy, it left there the seeds of disorders which ended in blindness, deafness, an active development of scrofula, consumption, and a diseased state of the mesenteric gland. The growing increase of small-pox had been attributed to diminution in the protective power of vaccination. There had no doubt been a considerable increase in the number of cases of small-pox of late years; but as he believed that the lymph was now as good as ever, the increase must be the result of indifference, and this showed the necessity for an interposition of the Legislature. That vaccination was perfectly preventive of small-pox, was proved by the testimony of an eminent vaccinator, the resident surgeon of the Small-pox Hospital, who stated last year that he had during the last few years vaccinated no fewer than 40,000 persons, and up to the present moment he had not been able to discover a single instance in which a person vaccinated by him had been subsequently attacked with the small-pox. It 1012 was perfectly correct, as had been stated by his noble Friend, that the small-pox was chiefly confined to the lowest class of the population, and he believed that with improved lodging-houses the disease might be all but exterminated. In almost every case where the small-pox had been introduced into the metropolis, or any other part of the country, it was traceable to an importation from the sister island, where there was no system of vaccination—an additional reason why such a system should be established there. It would be well also to introduce police regulations upon the subject, for he believed it would be found that in many instances the disease had been propagated by means of cabs, omnibuses, and lodging-houses. The effect of the compulsory system, when established in other countries, had been almost to exterminate the disease there. In Prussia it was compulsory, in Copenhagen it was nearly so, and in London and Glasgow it was permissive. There were, in every 1,000 deaths in Prussia of small-pox, 7.5; in Berlin, 5.5; in Copenhagen, 6.75; in London, 16; in Glasgow, 36; in Greenock, 34.6; in Bohemia, 2; in Lombardy, 1.5; in Venice, 2.2; in Sweden, 2.7. In Copenhagen, during 13 years, from 1811 to 1823, there had been but one fatal case of small-pox in a population, at that time, of 100,000. Vaccination was not compulsory in France; but the Vaccine Committee, in their last report, advised that France should at length follow the example of many other nations. The deaths were about, in every 1,000, 10.5; and the number had been only repressed by great exertions of Government. These opinions were maintained by some of the first medical names in Europe, and were founded on the testimony of at least 2,000 medical professors. In Paris, where the compulsory system was not established, the mortality was very great, and the medical board had reported that it was absolutely necessary that a system of compulsory vaccination should be introduced without delay. Indeed, the medical men in France quite agreed with those of this country, in thinking that the establishment of such a system was the only means of putting an end to the disease. It appeared from the last return that the total number of deaths in England from small-pox was 7,500, and in Ireland 5,800; those in Scotland not being known. Taking these data, it was estimated that the number of cases in England was 45,000, and in Ireland 34,800, or a total of 79,800; 1013 and if those in Scotland were added, it was supposed that the whole would be no fewer than 100,000. When the House reflected what fearful consequences resulted to the persons attacked with small-pox, they would see how absolutely necessary it was, for the safety and comfort of the population, that the compulsory system should be speedily established. Some persons might, indeed, take exception to such a system, as thinking that it interfered too much with the poor, and dictated to parents what they should do with their children. But why should not the House interfere to protect the public, and prevent children being made the centres of contagion to whole districts? But we had already interfered with the liberty of the subject on this matter to a great extent. Inoculation had been prohibited under a penalty, and from thence the transition to compelling vaccination seemed very easy. Interference in this case was requisite to protect the public, and prevent an infected locality becoming a nidus of disease which might extend through the whole community. The law had already interfered in a variety of ways to abate nuisances. They interfered to prevent the smoke and other nuisances in the City and elsewhere; and, for his own part, he hoped those efforts would be persevered in, and that the day would come when not a chimney-stalk, long or short, would be visible in the metropolis. Why, then, should they hesitate to introduce a measure of such benefit to society at large and to the public health? As to the amendments of which notice had been given, he must say he agreed in thinking that children should be vaccinated from the arm of a healthy child, for no doubt there was a prejudice against the virus from animals. If the Bill were properly carried out, and remuneration given to those engaged under it, he believed they would soon exterminate the disease; and he had not the slightest doubt that generations to come would thank their Lordships for the attention they had bestowed on that important subject, and on the blessings that had resulted from it.
§ The EARL of ELLENBOROUGH
said, he believed the system now in operation originated in a suggestion made by himself some years ago; but he must admit that, acted upon as it had been, it had not produced the beneficial results which he expected; and he must admit that the two noble Lords who had addressed the House had made out a sufficient case for a material alteration and 1014 amendment of the existing law, nor did he himself object to the principle of compulsion. He thought that under the circumstances we were justified in resorting to it; but he must say that when we compelled the poor, who had very strong feelings upon the subject, to have their children vaccinated, we should at the same time afford them facilities for the purpose of having the vaccination performed, and should consult their prejudices as to the manner in which it was to be done. The clause which he proposed to insert in the Bill, referred to the establishment of vaccination districts in poor-law unions, and for the attendance of a vaccinator on fixed days there, in order to save the poor from the necessity of going such long distances as they had now to do in some cases. There was nothing in the existing law to prevent boards of guardians from doing this, and it was in fact done in the union where he resided. He thought it was also desirable to provide that in every practicable case vaccination should be performed from the arm of a healthy child. They might, if the requisite facilities were given to the poor, very well say that no child who was not vaccinated should be admitted into any school, and that all persons applying for poor-law relief should be examined, and should not be relieved if they persisted in refusing to be vaccinated. Why, indeed, should they not also impose a penalty on the admission of unvaccinated persons in any manufactory? It was from large congregations of persons in manufactories and workhouses that the disease was spread, and measures should therefore be taken for insuring the vaccination of all persons who were assembled therein. Unless, however, some such arrngement as that which he had suggested were adopted, and the unions were divided into districts of convenient size, the inconvenience to which the poor would be subjected from having to come a long distance would be so great as to prevent the operation of vaccination being so generally performed as was desirable. He would suggest to the noble Lord (Lord Lyttleton), who had charge of the Bill, that it should be committed pro formâ for the purpose of reprinting it with the proposed amendments, and then recommitted on a future day.
§ House in Committee; Amendments made; House resumed; and to be again in Committee on Thursday next.
§ House adjourned to Thursday next.