ids stringlengths 36 36 | texts stringlengths 1 1.43k |
|---|---|
2aa13bd9-62fe-4e25-ae48-399633026259 | The Commissioners appointed were the following:—Farrer, Baron Herschell, Sir James Paget, Sir Charles Dalrymple, Sir William Guyer Hunter, Sir Edwin Henry Galsworthy, William Scovell Savory, Charles Bradlaugh, John Syer Bristowe, William Job Collins, John Stratford Dugdale, Michael Foster, Jonathan Hutchinson, James Allanson Picton, Samuel Whitbread, and Frederick Meadows White, Esqrs. On the death of Mr. Bradlaugh, John Albert Bright, Esq., was appointed in his place. During the succeeding years the Commissioners issued several interim reports containing the evidence taken before them. The final report was issued in 1896, and contains the conclusions at which the Commissioners arrived, in three separate reports. The majority report signed by all the Commissioners, except Mr. Picton and Dr. Collins, with separate reports on side issues by Sir W. Guyer Hunter and Mr. |
05d57747-4033-4d86-a8a5-2ff945f1e9ea | Jonathan Hutchinson, and a further note of reservation by Mr. Whitbread, Mr. Bright, Dr. Collins, and Mr. Picton. All these will be found on subsequent pages, with a dissentient report by Dr. Collins and Mr. Picton, giving the views of the extreme opponents of vaccination following. 6o The report of the Commissioners is as follows, the exact words of the report being here given. The only portions omitted are those which did not apply to the metropolis. We have held 136 meetings for the examination of witnesses, and have examined 187 witnesses. In addition to this, we have caused important investigations to be conducted for our assistance. On the eighteenth occasion on which we met, we were invited to make a personal examination of two children who were alleged to have suffered from the effects of vaccination. Some of the members of the Commission, at the request of their colleagues, made the desired examination. |
832bc909-bb70-4d8d-a266-29e7e6383a15 | It was felt, however, that it would be neither practicable nor expedient to pursue the same course in other cases in which injury from vaccination was alleged. Authority was accordingly obtained from the Treasury to secure the services of competent observers to make such investigations as might be called for. A large number of cases of alleged injury from vaccination brought to the notice of the Commission have thus been the subject of careful investigation. (A.) As to the effect of vaccination in reducing the prevalence of, and mortality from, small.pox. The first of the questions submitted to us by Your Majesty is as to ' the effect of vaccination in reducing the prevalence of, and mortality from, small.pox.' This is obviously a fundamental question. It has been strenuously maintained by some that vaccination has not had, and indeed, could not have had, any effect in controlling the spread of Small.Pox or in diminishing its virulence. |
90f2101e-4453-46af-8d84-d3abfbdc44c3 | They insist that the notion that it is, to any extent, a protection against Small.Pox rests on no scientific basis, that there is no relation between vaccinia and variola, and therefore no reason why those who have been subjected to vaccination should enjoy any immunity from, or protection against Small.Pox. They insist, further, that, as a matter of experience, it is not 61 proved that any such protection or immunity has been enjoyed by the vaccinated. The latter is manifestly the more important point. If the facts which have been accumulated, when fairly and impartially viewed, do really show that the vaccinated are either less liable to be attacked by Small.Pox, or if attacked suffer less severely, than the unvaccinated, any theory which rests on the basis that there is no possible connexion between vaccination and susceptibility to Small.Pox must evidently be regarded with distrust. |
ab9753cb-cd47-4e59-a702-fff00a7e087f | If the protective effect of vaccination be thus estabtablished, then, even if the relation of vaccination to Small.Pox could not be explained, nor the reason why or the manner in which it affects human susceptibity to Small.Pox contagion, elucidated, it would still be quite reasonable to accept and act upon the conclusions to which experience directed us. The reason why the introduction of a particular drug into the human body produces certain phenomena may be incapable of explanation, but that it operates to produce these phenomena may be none the less certain. If, then, it be shown that vaccination has a protective influence against Small.Pox, or modifies the character of the disease, it is not necessary for the purpose of the inquiry upon which we are engaged to determine what is the true theory by which the effect is to be accounted for. To embark on such a scientific inquiry in any detail would be beyond the scope of our functions. |
f799821d-c316-4040-9d94-2f585bbc1f2e | If, again, experience does not warrant the assertion that vaccination tends to prevent the spread or mitigate the effects of Small.Pox, it is obviously immaterial whether this was a priori to be expected. At the same time, as it has been asserted with much confidence that science forbids a belief in the protective influence of vaccination, we have not thought it right to abstain altogether from dealing with this question. We shall, however, for the reasons we have given, discuss it much less in detail than the question what inferences ought to be drawn from the facts accumulated by the history of vaccination and Small.Pox in the period, now nearly a century, during which vaccination has been in use. |
16f77cb6-5587-4437-9de6-63b77bb48785 | 62 The practice, however, of inoculating with the matter of Cow.Pox, or Vaccination as it was subsequently called, may be considered as dating from the publication of the ' Inquiry into the Causes and Effects of the Variolae Vaccinae,' of Edward Jenner, published in the summer of the year 1798. The practice rapidly spread, and prevailed widely in this country and other parts of Western Europe during the first quarter of the present century. It was, beyond all question, so adopted in the genuine belief that it afforded protection against Small.Pox. Two questions at once present themselves. First, upon what was this belief founded; and, secondly, does the history of Small.Pox mortality from the time when the practice of vaccination became prevalent, support the view that it has such a protective influence ? Vaccinia or Cow.Pox is a disease affecting milch cows and marked by an eruption on the udder and teats. |
b7b3ef4f-39c1-432c-a5fc-c7cd07cc3fb3 | The disease can be communicated from the cow to man. Dairymen and maids engaged in milking cows affected with Cow.Pox are apt to have sores of a special kind on their hands or elsewhere, the development of the sores being frequently accompanied by febrile symptoms. There can be no doubt that, in a certain number of cases at all events, such sores are the local manifestations of Cow.Pox; the virus from the eruption on the cow being introduced into some scratch or other imperfection in the skin of the milker and there producing its local effects, accompanied more or less by general symptoms. |
a74f526f-e489-4e92-b5d5-287db659f3b4 | In the treatise to which reference has been made Jenner records in the first place a number (19) of cases in which a person who had accidentally taken Cow.Pox from the cow, had never had Small.Pox and appeared incapable of taking that disease; the insusceptibility being shown on the one hand by the failure to contract the disease after ample exposure to contagion, such as nursing and attending to or even sleeping with persons suffering from Small.Pox. Jenner further recorded in the same treatise how he had, in 63 1796, inoculated a healthy boy of eight years of age in the arm with Cow.Pox matter taken from a sore on the hand of a dairymaid who had been infected with the disease by milking cows suffering from Cow.Pox. |
652a2995-34d0-4b77-bee6-66b84cdf6e8e | He describes the appearances subsequently presented by the wounds, and states that, six weeks afterwards, the results of inoculating the boy with variolous matter were those commonly seen to follow the inoculation of persons who had previously had the Cow.Pox or the Small.Pox; that is to say, the ' variolous test' showed the boy to be insusceptible to Small.Pox. Some months afterwards the boy was again inoculated, but no sensible effect was produced on the constitution. Jenner then relates that subsequently, in the spring of 1798, he inoculated a child, and obtained a similar result with matter taken directly from the nipple of a cow infected with Cow.Pox; from the pustule on the arm of this child he inoculated another, and from this again several, and from one of these latter a fourth in succession, and then a fifth. To three of these the 'variolous test' was applied, and it is stated with the same results. |
34092bc2-6ada-4bd4-8e50-93c43fa70568 | In January, 1799, Woodville, having found Cow.Pox to be present in a 'dairy' at Gray's Inn Lane, inoculated seven persons at the Small.Pox Hospital with matter from one of the cows at the " dairy," and other persons with matter from sores on a dairymaid employed at the same place, who had become infected from the cows. From these cases he inoculated in succession others at the Hospital, eventually to the number of many hundreds, and thus established the stock of what has been spoken of as " Woodville's lymph." Pearson also at the same time occupied himself with the question of inoculation with the CowPox, writing a pamphlet about it. Woodville and he distributed to many persons in this country and abroad quantities of the lymph from the Hospital; and this was the beginning of the more general practice of vaccination, for Jenner's stock of lymph, the results of which he had described in his treatise, had come to an end. |
35eed9cd-d529-48cb-b998-3c5126a4fd7e | 64 Although Woodville's 'Hospital lymph' appears to have been widely distributed by himself and by Pearson, and thus to have been the source of the lymph used in various places in the early days of vaccination, it was not the only source even in those days. Pearson also obtained lymph from Cow.Pox at a dairy in the Marylebone Road, and used this 'in certain situations,' which may be presumed to include places elsewhere than in the Hospital. He also speaks of having obtained lymph from the cow from a third source. Jenner again, who received and used some of Woodville's Hospital lymph, also obtained lymph from some other courses; for instance, from a cow at a Mr. Clark's farm in Kentish Town. Further, Woodville, in 1800, speaks of his having at various times procured the vaccine virus as produced in different cows, which, when used at the Hospital, produced the same effects as the Gray's Inn Lane lymph. |
b736cf6a-1e34-4501-b821-47c5b9b1b7e5 | The view that Cow.Pox protects against Small.Pox thus put forward by Jenner, and supported by Woodville and Pearson, speedily attracted great attention among both the profession and the general public. Controversies, as might be expected, arose both on the main point whether protection was really afforded and on various subsidiary points; but, within a very short time, the new doctrine found general acceptance in England. In 1800 a declaration of adhesion to the doctrine was issued with the signatures of many of the leading physicians and surgeons of London, and to this in the following year many others added their names. In various large cities the resident medical men made known collectively their approval. In 1802 a Committee of the House of Commons made a report on the utility of the discovery of the protective power of Cow.Pox, and upon Jenner's claim to be considered as the discoverer. A number of witnesses of extensive experience in the profession were examined. |
e5a59e9a-9913-41b9-a07d-5ab08952af2f | It is important to notice that the Committee not only stated the result of the evidence to be favourable to the protective effect of vaccination, but that vaccine 65 inoculation 'introduces a milder disorder in the place of the inoculated ' Small.Pox, which is not capable of being communicated by contagion.' If vaccination have the protective influence alleged, in view of the extent to which we have shown that it was practised in the first quarter of the present century, its fruit ought to be seen in a diminution of the mortality from Small.Pox during that period. This brings us to the second of the two questions which we have said presented themselves. Does the history of Small-Pox mortality since vaccination was introduced afford warrant for a belief in its protective effect ? This, of course, involves an inquiry into any other possible causes affecting the amount of Small.Pox mortality. We enter then upon the first stage of this inquiry, confining our attention for the present to the period we have indicated. |
e3be5ec2-a826-492e-a564-709fc8379f75 | It becomes necessary at the outset to consider the subject of Small.Pox mortality and its prevalence prior to the introduction of vaccination, and especially during the latter part of the eighteenth century, the period immediately prior to its introduction. The early history of Small.Pox, like that of many similar diseases, is obscure, is subject to much debate, and, save perhaps on one point, is of antiquarian interest only. The records of the eighteenth century show that the disease was very prevalent in Western Europe during the whole of that century ; we shall discuss the history of the disease during that period in some detail presently. The records of the seventeenth century also show that Small.Pox was a very common disease during that century ; this especially the case as regards the latter half of the century. |
75740a72-3753-47b9-8620-862b88fae470 | The statistics which exist with respect to Geneva, and various scattered statements, further show that Small.Pox was a well.known disease in the sixteenth century, but except for the records which are said to exist of severe 66 epidemics in Iceland taking place as early as 1241, as we go further back the evidence as to the existence of the disease becomes less and less clear, and indeed debateable, depending as it does largely on the interpretation of incidental statements in various medical and other writings. There seems, however, to be adequate proof of the prevalence of Small.Pox in the East, in Asia Minor and other countries, even in the earlier centuries of the Christian era. A view very generally taken teaches that Small.Pox introduced from the east, began to be common in western Europe during the fifteenth century, though perhaps existing still earlier, that it increased during the sixteenth and seventeenth centures, especially the latter, and that it was very prevalent during the eighteenth century. |
702fd8cd-cdc5-497a-b058-2866d3d79c00 | It will be desirable not to discuss this view at length, but to confine our attention to the history of the disease in the seventeenth and eighteenth centuries. Quite apart from all calculations, the Bills clearly show that from 1629 onwards, throughout the remainder of that century and the whole of the next, very many persons died in London from Small.Pox. During the latter half of the seventeenth century the yearly deaths fell below 500 on eight occasions only. The return of one year, 1666, conspicuous for the smallness of the number of deaths (38 only) is intelligible when it is remembered that this is the year succeeding that of the Great Plague. The Bills also show that in both centuries the disease had an epidemic character, the returns of certain years being much greater than those of others. |
56f4138c-7246-4a32-8912-6fe7a94374dc | In many instances the epidemic increase is marked in one year only, the returns of the succeeding year being, as a rule, low, but not unfrequently the epidemic lasted over two or more years; and this appears to have occurred more frequently in the eighteenth than in the seventeenth century. Indeed, the variations of the numbers are, as a rule, more abrupt in the latter than in the former period. When we turn to the important question of the mortality 67 from Small.Pox, that is to say, the proportion of deaths to the number of persons living, we are met with the difficulty of the population not being exactly known. As already stated, it has been calculated that the population in 1685 was 530,000. |
77662c0a-b45e-4876-8e97-6e0f12fdb947 | On the basis of this datum, the average yearly death.rate of, or mortality from Small.Pox in the ten years around this date, namely, in the years 1681.90, was 3.139 per thousand; the mortality from all causes of death being 42.2 per thousand. Similarly in the ten years 1746.55, on the calculation that the population in 1750 was 653,900, the yearly mortality from SmallPox was 3.044; that of deaths from all causes 35.5 per thousand. Taking the same calculations as to population we find that in years when the deaths from Small.Pox were very high, the mortality from Small.Pox, both in the seventeenth and eighteenth centures, was frequently 3, 4, 5, or even more per thousand. |
f0ceea5b-ecde-433b-8154-448096b767f2 | Even if we take the years in the eighteenth century in which the returns of deaths from Small.Pox were the lowest, viz., 1702, 1753, 1782, we find, still using the above calculations, the mortality from Small.Pox o.6, 1.2, and 1.o respectively, and in 1797, using the census of 1801, the death.rate was 0.7. And in most of the years of that century the mortality from Small.Pox was either not far below, or very distinctly above, 2 per thousand. All this means, even when every allowance is made for the insecurity of the calculations, that the mortality from Small.Pox in London was, during the eighteenth century, very high. This is a broad conclusion which may be considered as definitely proved. |
b4ec9d98-9c37-4de4-b5b2-10c134ab9002 | Thus Daniel Bernouilli, writing in 1760.5, takes as one of the bases of his circulation the datum (arrived at by means of various records in various places) that Small.Pox carries off the thirteenth or fourteenth part of each generation ; or in other words, that the deaths from Small.Pox are about one.thirteenth or one.fourteenth of the deaths from all causes. The same author uses another datum obtained in a similar way, namely, that the eighth or the seventh part of those attacked die of it. From this, it follows that something like 40 per cent. of those 68 born died without having Small.Pox. Since of these so dying a large number died at an early age, the number of those dying in adult and in advanced age without ever having had the disease would be much less. |
f9437d9e-cb08-4fb6-9a86-ce912c8f01f1 | And in this sense, probably, must be read the statement of Haygarth, which he gives without supplying the data on which it is based, namely, that ' some persons are incapable of infection by the Small.Pox.' The ' proportion of mankind thus exempted has been observed to amount to i in 20;' that is to 5 per cent. The persons here referred to are probably those who lived to an advanced age without taking Small.Pox, though exposed to infection and possibly (for Haygarth wrote in the inoculation period) subjected to inoculation. The records of the London Small.Pox Hospital from 1746 to 1763 showed a fatality of 28.3 per cent., and it has been stated that during the last 25 years of the last century 32 per cent, of those admitted succumbed to the disease. |
a7767b01-fa87-4ac1-869f-6d76b55ae2a6 | One character of the Small.Pox in the eighteenth century (and there is nothing to prove the state of things before the eighteenth century to have been different) is brought out in all the records in which the ages are given, namely, the large proportion of the deaths contributed by the very young. Thus, in Chester, in the epidemic of 1774, all the 202 deaths were of those under ten years, and a quarter of them under one year. In Warrington in 1773 all the deaths were of those under nine years. In Kilmarnock, of the 622 deaths occurring between 1728 and 1763, the ages of nine not being given, only seven were of those above ten years. The burial registers for the graveyard of St. |
6976a2f1-4a2b-43ac-852a-a32c5a0459fb | Cuthbert's, Canongate, and Buccleuch Street, Edinburgh, show that during the years 1764—83 the proportion of deaths from Small.Pox of those below the age of ten years, to every thousand deaths from that disease at all ages, was 993. Indeed in all records of epidemics in which the ages are given, the mortality was mainly amongst infants. It is also seen in the larger records, covering periods, including both epidemic years. 69 and years which were not epidemic, as in those of Geneva (1580— 1760), which show that the feature was apparent earlier than the eighteenth century, in those of Sweden (1774—1800) and in those of other places. |
78e08deb-6ef2-4390-9f8e-a30bf679b703 | Incidental references in various writings show that the fact was recognised at the time; thus Haygarth observes that in Chester in the years 1772—1777, of those under ten years, 'half as many die of the Small.Pox as of all other diseasesand this feature of Small.Pox is assumed in the calculations of Bernoulli referred to above. The first quarter of the 19th century was characterised in this and other countries by a striking decrease of Small.Pox. In the London Bills of Mortality the returns of Small-pox for the year 1800 are 2,409. This was the last return so high as 2,000. From thence onward, the number of deaths from SmallPox fell, especially after 1810, reaching in 1818 so low a figure as 421 ; the fall being irregular and marked by epidemics as in 1812, 1817, and 1825. |
16da98f7-68e1-4fe4-8be7-4328dbfaf152 | This decline is all the more'striking since during this period the population of London, within the limits of the Bills, increased from 746,233 in 1801 to 1,180,292 in 1831. As has been already urged the Bills were imperfect, and there is ground for believing that during this quarter of the century the imperfections were greater than in former times. This is confirmed by the fact that the returns of the total deaths, in spite of the increased population, were on the whole not greater, in many years even less, than in the preceding century. Making evety allowance for the effects of improved sanitary conditions, this feature of the returns may be taken as evidence of their imperfection. Still, in spite of their imperfect character, the Bills show that during this quarter of the century, a striking change took place in Small.Pox in London. |
0c29aa6f-3c5f-4b1f-bbc9-1d0a3c6c0188 | What was the cause, or what were the causes, of this marked decline of Small.Pox in the first quarter of the nineteenth century ? Was it due to the introduction of vaccination, or is it to be otherwise explained ? 70 One effect of the introduction] of vaccination was a very great decrease in the practice of inoculation, which had become very prevalent during the later part of the previous century. And the view has been put forward that, the prevalence of inoculation having greatly increased the amount of Small.Pox, the diminution of Small.Pox in question was the result of the decrease of inoculation. The practice of inoculation for the Small.Pox, that is, the artificial introduction of the virus into the system by the insertion of fluid from a variolous pustule into wounds of the skin made for the purpose, began definitely in England towards the end of the first quarter of the eighteenth century. |
0a4b2283-5543-4ce2-bd00-aa9b1a06522c | Attention was directed to the latter by letters from Timoni, of Athens (dated 1713), and Pylarini, published in the twenty.ninth volume of the ' Philosophical Transactions ' (1716), and especially by a letter from Lady Mary Wortley Montagu in 1717. Though there are indications that in Great Britain and Ireland, as in other countries, some sort of inoculation had occasionally been practised at a much earlier date, the first clearly recorded case in England is that of the daughter of Lady Mary Wortley Montagu (whose son had sometime before been inoculated at Constantinople), inoculated by Maitland, in London, in April, 1721. Other cases soon followed in England, and about the same time the practice was also introduced in other countries of Western Europe, and into the United States of America, namely, at Boston. |
5be74d41-05ed-4253-b5b2-bb4aa2c16c9f | It was found that the attacks induced by inoculation were, as a rule, milder and very much less fatal than the attacks of the ' natural' disease, the fever and constitutional disturbance being less and of shorter duration, and the eruptive pustules much fewer ; the number of these varied, being commonly a dozen or two, sometimes only two or three, sometimes a hundred or more. In some cases there was no eruption at all, the effect being limited to constitutional disturbances and to changes in the wounds of inoculation themselves ; it was maintained that in such cases the 71 disease had really been taken, and immunity against a subsequent attack secured, as in cases of natural Small.Pox, or of inoculated Small.Pox manifesting itself in an eruption of pustules In England the practice of inoculation at its introduction, though much lauded and strongly urged by some, was bitterly opposed by others. |
0c1fdf87-8b56-48b0-b42a-6dc549c8540c | Moreover, the initial enthusiasm in favour of it soon declined, so that in the years 1730.40 very little inoculation seems to have been practised. About 1740, however, a revival appears to have taken place ; in 1746 an Inoculation and SmallPox Hospital was started in London ; and during the whole of the latter half of the eighteenth century the practice may be said to have been very general. It was especially so during the last quarter of the century, the increase being at least largely due to the ' improved methods' of inoculation introduced by one Sutton in 1763 and known as ' the Suttonian method.' |
ac0cfd4d-131d-446f-a403-f6c7169c8b99 | This method, carried out by Sutton himself and his immediate associates, as well as in a more or less modified form by Dimsdale and others, had for its object the securing that the attack induced by inoculation, while remaining a veritable attack of SmallPox and so bringing immunity against future attacks, should be as mild as possible; that the constitutional disturbance should be slight and of short duration; that the eruptive pustules should be few, or even absent altogether; and that a fatal issue, the somewhat frequent occurrence of which had, in the early days, been a great obstacle to the spread of the practice, should be rendered at least very rare indeed, if not impossible. |
b1cfc568-f994-419e-9da2-4e8fd3f95307 | Concerning the essentials of the method, which Sutton attempted to keep a secret, there has been much discussion; they seem to have consisted partly in a proper care or regimen of the patient before, during, and after the inoculation, partly in the mode of inserting the virus, and partly in making use of the fluid of the variolous vesicle at a relatively early stage. There can be no doubt that between the years 1770—1780 inoculation was very widely practised in England, and there is 72 no evidence to show that any marked decline in the practice took place during the remainder of the century. But the distribution of the practice was very unequal. It was much more common among the rich, or at least, among the well.to.do, than among the poor, though many benevolent efforts were made ' to extend its advantages' to the latter. |
ce12749f-c6eb-47c1-bb9e-65b0cd617925 | Again, in some districts, as in Essex and Herts, the home of Sutton and Dimsdale, and in Yorkshire, the practice was very widespread. On the other hand, parts of Kent and Sussex are quoted by Haygarth in 1793 as having been practically free from inoculation, and similar statements as to the paucity of inoculation in this or that district are made by other writers of about the same period. There are no records giving exact information as to the amount of inoculation practised in London, but, seeing that it was favoured by the rich, and that on the other hand opportunities for the poor were afforded by the Inoculation Hospital, we may, perhaps, conclude that the practice was at least very general. What influence, then, had the practice on the prevalence of, and on the mortality from, small.pox, during the latter half, and especially during the latter quarter, of the eighteenth century ? |
b5b2cd89-52d1-4cc6-b721-72882885845a | Since an inoculated person was infectious, each inoculation was a source of danger to those, not protected by a previous attack, who came into the company of, or even near, the inoculated person during the attack; and this danger was increased by the fact that the mild character of the inoculated disease permitted, in many cases at least, the patient to move about among his fellows. Moreover, as Haygarth, himself a zealous advocate of inoculation in a systematic regulated manner, points out, the beneficial results of inoculation had robbed the disease of its terrors to so great an extent that the rich and powerful no longer made the efforts which they formerly did to prevent its entrance into, or its spread in, their neighbourhood, and thus favoured its spread among the unprotected poor ; so that inoculation,' though eminently useful to the rich appeared to be injurious to the poor.' |
4f07e1a4-92e9-49ff-94f8-66a91e88b9e6 | 73 Adding, therefore, together the cases of inoculated Small.Pox, and the cases of natural Small.Pox of which the inoculated cases were in one way or other the cause, it seems probable that inoculation did tend to increase the prevalence of Small.Pox; but there are no recorded data to show that this really was the case, and this supposed influence may have been counter.balanced by other influences. The general conclusion which may be drawn seems to be that inoculation had a double influence, one favourable, the other unfavourable, as regards Small.Pox; and, owing to the conflict between these two influences, it produced but little effect upon the prevalence of or mortality from Small.Pox. There is no adequate evidence that inoculation did increase the mortality from Small.Pox. |
364e904e-5507-44fe-b431-f33971421158 | There was certainly, so far as the evidence goes, no such increase of Small.Pox, coincident in point of time with the increase of inoculation, as to justify the decrease of the latter being considered the main cause of the marked decline of the former. Nor is there sufficient even to show that it was a distinct subsidiary cause. It is to be observed that some opponents of vaccination, whilst insisting that the decline in Small.Pox mortality in the first quarter of the present century was due to the discontinuance of the practice of Small.Pox inoculation, have contended that what was supposed to be vaccination during that period was in reality inoculation with Small.Pox virus. It is obvious that these theories are mutually destructive. If the so.called vaccination was in truth Small.Pox inoculation and the latter practice increases the prevalence of Small.Pox, the disease should have increased and not diminished during the period under review. |
9de1a069-80e0-4126-9e91-9c22ebad82c1 | Another view has been put forward attributing the decline in question to the improvement of sanitary conditions. The question how far the behaviour of Small-Pox in the 74 eighteenth century and earlier was influenced by sanitary conditions, is one rendered difficult by the lack of exact information. We may distinguish between overcrowding as one insanitary condition and all other insanitary conditions, such as lack of cleanliness and the like. A priori we should expect that a dense population, especially one of great internal movement, and one in continual interchange with surrounding populations, by offering greater facilities for the conveyance of contagion, would lead to a greater amount of Small.Pox. |
0aeaa1f4-55c5-4f4b-83a6-1c71c2abb691 | London was a conspicuous instance of the above, and the apparent greater prevalence of Small.Pox in London than in the provinces may be attributed to these causes; but it would appear that the increase was felt, as indeed would, a priori, seem probable, rather in the constant presence of Small.Pox to a considerable amount at all times than in the mortality of the epidemics when these occurred. It may be urged against the view that the decline of Small.Pox was due to improved sanitary conditions, in the first place, that, admitting the introduction of sanitary improvements, no evidence is forthcoming to show that during the first quarter of the nineteenth century these improvements differentiated that quarter from the last quarter, or half, of the preceding century in any way at all comparable to the extent of the differentiation in respect to Small.Pox. |
0aaeca9e-76fc-4e47-85b8-6678dd6a1ed6 | In the second place, admitting a priori that crowded dwellings tend to increase the liability to contagion, and so the prevalence of the disease, while other insanitary conditions tend in addition to increase the fatality among those attacked, so that insanitary conditions as a whole must tend to increase the mortality from Small.Pox ; no evidence is forthcoming which distinctly shows that the dependence of the prevalence of, or the mortality from, Small.Pox, on the lack of sanitary conditions, was a feature of the history of Small.Pox during the eighteenth century. Moreover, it must be remembered that the decline in Small.Pox mortality was observed in Western Europe in countries 75 where the sanitary conditions were widely different. Whatever may have been the sanitary improvements during the first quarter of this century in England and some other countries, there seems no ground for supposing that throughout Western Europe the period was marked by great changes in the direction of improved sanitation. |
611a4f5d-9e3a-4803-b439-f1a41ed42f88 | Indeed, in many countries, down to a recent period, in some, it may perhaps be said, even to the present time, insanitary conditions have continued to prevail. There is no proof that sanitary improvements were the main cause of the decline of Small.Pox under discussion. And no adequate evidence is forthcoming to show to what extent such improvements may be considered as a subsidiary cause. The decline in question followed upon the introduction of the practice of vaccination. The records of Western Europe and the United States show that, in all places whence returns were obtained, the introduction of vaccination was followed by a decline of Small.Pox ; the decline becoming especially apparent after the lapse of such time as may be supposed to be necessary for the due spread of the practice. Moreover, the spread of the practice and the decline of the disease do not stand as two phenomena simply following the same course, but without any tie joining the two. |
05711449-7450-40fb-8254-f6ee35722e94 | The experimental evidence offered at the time, namely, that the class of vaccinated persons did not take Small.Pox by way either of exposure to natural contagion or of inoculation, as the unvaccinated did, connects the two and points to the spread of the practice as the cause of the decline. It has been suggested that the decline was due to some general unknown conditions, which have been spoken of as 'cosmic' or 'secular.' It has been urged that such general ' cosmic' conditions led, on the one hand, to the spread of Small.Pox in Europe during the seventeenth and especially during the eighteenth centuries, and, on the other hand, conversely to its 76 decline in the beginning of the nineteenth century. The possibility of such general 'cosmic' conditions influencing Small-Pox cannot be denied; but at present, at all events, the appeal to such conditions is the result, not of positive knowledge, but of our inability to explain the phenomena otherwise. |
41122a61-6787-4ad3-9f85-2cb48b842772 | Moreover, it is not certain that the relative paucity of Small-Pox in Europe before the seventeenth century was not apparent rather than real, being due merely to absence of information; if so, there is no necessity to seek in 'cosmic' influences the cause of the supposed later increase. In attempting to judge of the decline in question being due to such 'cosmic' influences, we are met with the difficulty that exact records of the prevalence of Small-Pox during the period under discussion are wanting in respect to countries where vaccination was not practised. But such information as is available goes to show that in the countries where vaccination did not become general, Small-Pox prevailed in the first quarter of the nineteenth century very much as it had prevailed in the eighteenth. Thus, in Egypt vaccination was not introduced until 1827, and up to that time Small-Pox was extremely prevalent; the decline, which in Western Europe was marked during the first quarter of the century, appears to have been absent there. |
4b098cc3-6862-4413-b95f-60a981463a3d | Again, in America, though in the early days of vaccination, efforts were made to spread the practice among the native tribes, these (especially the tribes of the West) remained unvaccinated, and among them the ravages of SmallPox in the first quarter of the nineteenth century are described as of extreme severity. So in Brazil, vaccination, though introduced early, was not carried on with the same energy as in Europe, and here severe epidemics of Small-Pox occurred. There is no adequate evidence of a decline in unvaccinated countries like that which took place in vaccinated countries, and there is no sound reason for attributing the latter to any theoretical 'cosmic' influences. Upon the whole, then, we think] that the marked decline of 77 Small-Pox mortality in the first quarter of the present century affords substantial evidence in favour of the protective influence of vaccination. It has been urged that the decline was too great to have been due to the amount of vaccination which prevailed. |
b2e2b0f3-1d37-45e8-868f-85032129d6ac | It has been shown, however, that the amount which was carried out was very considerable, and the argument that such an amount was insufficient to produce the decline in question is based on the premiss that such an amount of vaccination would at the present day be considered wholly insufficient protection. But it must be borne in mind that in the countries so often mentioned a large proportion of the population were protected by previous attacks of Small-Pox, either natural or inoculated ; only a portion of the population needed the protection claimed for vaccination. And if the vaccination in the early years of the century was as general as we have seen reason to think it was, that, added to the protection afforded by previous attacks of Small-Pox, may be regarded as adequate to have produced the decline in question. |
58fea682-1fca-4170-834d-69357fa9a90c | Of course, as years went on, the proportion of the population immune through previous Small-Pox became, owing to the mere decline of Small-Pox, continually less and less, as the large number who had had the Small-Pox in the previous century gradually died out. After the first quarter of the century, that part of the population which depended for immunity on vaccination alone, became, in the absence of serious epidemics, greater and greater; and an amount of vaccination adequate to afford great protection in the earlier years ceased to be adequate for the latter years. But this brings us to the periods succeeding the first quarter of the century, which will be considered hereafter. We have dealt thus with the evidence afforded by the first quarter of the present century, because it constituted a convenient epoch for inquiring whether mortality from Small-Pox had shown signs of diminution in the period immediately succeeding the introduction of vaccination, and not because the close of that 78 quarter of a century was in any respect a dividing line. |
6b9d38e9-fca3-4560-bf95-1da02212cef7 | So far as England is concerned a new epoch commenced in 1837. There was nothing to distinguish the phenomena observable between 1825 and 1837 from those of the preceding years of the century, and the only mortality statistics in our possession relating to those intervening years became not more but less accurate and satisfactory. In the year 1837, however, the present system of registration of deaths commenced in England, so that from that period more exact statistics of Small-Pox mortality are available. In Scotland a similar system of registration was not initiated until 1855, and in Ireland until 1864. In the latter country, however, information with reference to the mortality in preceding years was, prior to the registration of deaths, acquired when the decennial census was taken. This practice commenced at the period of the census in 1841. |
3fbfc833-6972-4231-8dee-d0c30281b4ba | Before proceeding to inquire what light the records of Small-Pox mortality in England, Scotland, and Ireland, during the years when more accurate information has existed as to Small-Pox mortality, throws upon the question of the effect of vaccination, it will be convenient to make a brief statement of the laws which have been from time to time passed with reference to that practice. This is important, because it has been argued that a connexion may be observed between the diminution of Small-pox in the epochs subsequent to the different Acts passed by the Legislature, for the purpose of encouraging or compelling vaccination, and the increase of vaccination which would naturally result from those enactments. Although the House of Commons had made grants to Jenner in 1802 and 1806, and annual grants to the National Vaccine Establishment, which was founded by Royal Warrant in the following year, no statute was passed dealing with the matter until the 23rd July, 1840. |
47155f22-e2aa-4a7b-8b4a-ebbc13f7c83c | On that day the Act 3 and 4 79 Victoria, chapter 29, entitled ' An Act to extend the practice of vaccination,' received the Royal Assent. By that Act the Guardians and Overseers of every Parish or Union in England and Wales were empowered, and they were thereby directed to contract with their medical officers or with any legally qualified medical practitioners for the vaccination of all persons resident in such Unions or Parishes respectively. Payments were to be made dependent on the number of persons who, not having been previously successfully vaccinated, should be successfully vaccinated by the contracting medical officer or practitioner. In making their arrangements Guardians and Overseers were, by section 2, to conform to regulations made by the then existing Poor Law Commissioners, who had power conferred on them for the purpose. By the eighth section of this statute inoculation of the Small-Pox was declared to be illegal and the use of it was made penal. |
6ffcabc1-0a04-46cb-bcd2-26897ffdd92b | In the next year, on the 21st June, 1841 (4 and 5 Victoria, chapter 32), there was supplementary legislation (1) charging the expenses of carrying out the Act of 1840 on the poor rates and (2) enacting that ' the vaccination, or surgical or medical assistance incident to the vaccination of any person resident in any Union or Parish, or of any of his family, should not be considered parochial relief,' nor should he, by reason ' of such vaccination or assistance be, deprived of any right or privilege or be subject to any disability or disqualification whatever.' |
6465a3f6-97c4-4a4f-a40d-8c740e84d5b0 | These Acts were repealed by the Consolidation Act of 1867, but the Act of 1840 is important historically as being the first of the series of Acts relating to vaccination ; and especially so because of the terms of the eighth section forbidding inoculation ; and, again, because it not only speaks of vaccination itself, but of surgical or medical assistance incident to the vaccination, which contemplates the duty of providing the surgical 80 or medical assistance which the operation might render necessary or expedient, and the necessary expenditure in respect thereof. It is to be further observed that in the legislation of 1840 and 1841 there was no compulsion on parents or others to procure or to submit to vaccination. The services of the vaccinator were to be provided, and he was to vaccinate all who might choose to come to him for that purpose. It is not clear whether re-vaccination was contemplated. |
bec73ba4-1496-41a7-8802-baaae437f040 | Although there is a difference in the language of sections 2 and 6 relating to England and Wales and Ireland respectively, yet it is probable that, looking to the mode of payment provided in section x, a second vaccination was not contemplated by the Act. At the suggestion of the Epidemiological Society, which had been formed in 1850, Lord Lyttelton introduced into the House of Lords the measure which afterwards passed into law on the 20th August, 1853, without opposition or division. This was really the first measure for compulsory vaccination. It is entitled ' An Act to extend and make compulsory the Practice of Vaccination.' It applied only to England and Wales. |
da1f8927-76fb-4e52-8c5d-ca065248b5aa | The principal provisions of this Act were as follows :—The Guardians and Overseers, when the Parishes were not in union, were required, subject to the approval of the Poor Law Board, to divide their Unions and Parishes into convenient districts (section 1) for the purpose of giving increased facilities for the vaccination of the poor. They were to appoint a convenient place for the attendance of the vaccinator, and to give notice of place and time when he would attend to vaccinate, and to inspect the progress of the vaccination. The vaccinations were limited to those persons only who had not already been successfully vaccinated. It seems, therefore, that re-vaccination was not contemplated by this Act. The second section contains the compulsion. |
fbbb426e-2f32-4eb9-88e4-3ea070d0de12 | It was enacted that within three months of the birth the father or mother, 81 or, in the event of their death or inability, the person in charge of the child, within four months, should take the child to the appointed vaccinator, unless such parent or person should have obtained a certificate of previous vaccination from some other practitioner; and the vaccinator was required thereupon, or as soon after as it might be conveniently and properly done, to vaccinate the child. It was enacted by the third section, ' Upon the eighth day following vaccination the father, &c., shall take or cause to be taken the child to the vaccinator for his inspection that he may ascertain the result of the operation.' By the fourth section it was provided that the vaccinator was to give a certificate of successful vaccination to the father, &c., and to transmit a duplicate to the Registrar of Births and Deaths of the SubDistrict in which the vaccination was performed. |
f901a7f9-f56b-427e-902a-8b32e7139b86 | Section 5 made provision for children who, in the opinion of any medical officer or practitioner, were not in a fit and proper state to be successfully vaccinated. In such a case the medical officer or practitioner was to deliver a certificate to that effect, which was to remain good for two months, and to be renewable from two months to two months until the child should be considered fit for vaccination, when it was to be taken to be vaccinated. So long as the certificate or its renewal should last, it was a sufficient defence against any complaint against the father, &c., for non-compliance with the Act. Then followed provisions as to the duties of the Registrar. The Registrar of the Sub-District was to keep a register of persons whose successful vaccination certificates had been transmitted to him by the vaccinator. |
3561fa92-d25b-43c3-b959-365da9e9d7be | By section 9 the Registrar was required on or within seven days from the registration of the birth of a child to send to the father, &c., notice in a given form, to take care that the child should be vaccinated, and of the time and place of the attendance of the vaccinator ; and it was enacted that if after such notice the father, &c., of the child should not cause the child to be vaccinated, or should not on the eighth day after vaccination take, or cause to be taken, the child for inspection, then the father, F 82 &c., should forfeit a sum not exceeding 20s. These penalties were recoverable before two Justices according to 12 Vict. c. 43., and paid into the funds for the relief of the poor. |
7462f66e-a090-4319-87cc-83daed561f12 | The statute just referred to, though repealed, is notable by reason of a legal decision upon it, which probably gave rise to an amendment of the law by a subsequent statute, out of which difficulties arose which will be shortly referred to. In the case of Pilcher v. Stafford, reported 4 Best and Smith, 775: 33 L.J. (M.C.) 13, the Defendant had on the 18th February, 1863, been convicted and fined 2s. 6d. on an information and summons brought before Magistrates by the Registrar for a breach of this Act, in not having, after notice and within three months of the birth, taken his child to the appointed vaccinator for vaccination. Subsequently, the child not having been vaccinated, the Registrar brought a fresh information and complaint for the same cause. |
2f13cedb-352b-4aa8-b339-5f5b446fc664 | The Justices dismissed the information because they held that the offence of not taking the child to be vaccinated within the three months was a single definite offence, and that the Defendant, having been once convicted and fined for this offence, it was contrary to law to convict and fine the Defendant a second time for the same offence. The Court of Queen's Bench (Cockburn, Chief Justice, and Blackburn and Mellor, Justices) on this ground decided against the Registrar, and confirmed the decision of the Magistrates. The Act of 1867 (30 & 31 Vict. cap. 184) besides being a consolidating statute introduced some important additional provisions. The sections which it is important to notice contained the following provisions :—Sections 1 and 3 dealt with the division of the county into Vaccination Districts. |
b6cf5ebb-5128-4937-ad62-aaa7c9505055 | This was to be done by the Guardians under the control of the existing Poor Law Board, to which body, in 1871, by virtue of the statute before referred to, the Local Government Board succeeded. The contracts and their form were also to be subject to the approval of the Poor Law Board. The Privy Council were authorised to pay to the Public 83 Vaccinators additional sums to those which the Guardians and Overseers had to pay under their contracts. The intention of this clause appears to have been to enable the Privy Council to reward the Public Vaccinators for good and successful work, and to stimulate their diligence and care in the performance of their duties. The following clause increased the remuneration to be allowed to Public Vaccinators to not less than 2s. where the vaccination was performed at more than a mile, but less than two miles, from the residence of the vaccinator, and to not less than 3s. |
82ab35ce-b2a1-41e5-a1ba-874eebd59ae9 | where the vaccination was performed at a distance exceeding two miles. " By the eighth section provision for the encouragement of re-vaccination was specifically made by Parliament. The Privy Council was authorised to issue regulations in respect of the revaccination of persons who might apply to be re-vaccinated ; and in that case the Guardians were required to pay fees for successful re-vaccinations performed in accordance with such regulations of an amount equal to two-thirds of the primary vaccination fees. It would appear from the language of this section that the wording of some existing contracts had included re-vaccination. By the eighth section, however, it was enacted that these contracts should not apply to re-vaccination upon the Act coming into operation. |
0c7a577e-f282-4b95-a2c5-8b570918539d | The 16th section enacted as to every child born in England that within three months after the birth of such child, or where by reason of the death, &c., of the parent, any other person should have the custody of such child within three months after receiving such custody, the parent or such person should take it or cause it to be taken to the Public Vaccinator ... or should within such period cause it to be vaccinated by some medical practitioner. If the child were brought to a Public Vaccinator in compliance with the conditions in the Act he was required to vaccinate the child. |
75bbb49c-c321-4cd0-b258-02eb55e9aa06 | By section 17 it was enacted that upon the same day in the week following, in cases in which the operation was performed by the Public Vaccinator, the parent or person must again take the 84 child to the vaccinator or his deputy, so that he might inspect the child and ascertain the result of the operation, and, if he should think fit, take from such child lymph for the performance of other vaccinations; in the event of the vaccination having been unsuccessful, the parent or other person was required, if the vaccinator so directed, to cause the child to be forthwith again vaccinated. By section 27 a new and important provision was made with reference to the enforcement of the Act. This provision was repealed by the Act of 1871, and another scheme of legislation adopted, to which future reference will be made. |
fbafd540-02cd-4d5a-bc32-4625215baea8 | By this section it was enacted—' The Registrar of each District shall, within one week after the first day of January and the first day of July in each year, make a list of all cases in which certificates of vaccination have not been received by him during the preceding half year, and shall submit the same to the next meeting of the Guardians for whom he acts, and the said Guardians shall forthwith make enquiries into the circumstances of the cases, and if they find that the provisions of the Act have been neglected, shall cause proceedings to be taken against the persons in default.' This section imposed a duty on the Guardians to prosecute, and section 28 provided for their expenses, and authorised them to pay any officer appointed by them to prosecute persons charged with offences against the Act or otherwise to enforce its provisions. Provision for the appointment of such officers had been made by the Act of 1861, 24 & 25 Vict., c. 59, and their appointment was afterwards by the Act of 1871 made compulsory. |
6504e353-dce0-458a-a3ea-7e100e683327 | By section 29 it was provided as follows:—' Every parent or person having the custody of a child who shall neglect to take the child or cause it to be taken to be vaccinated, or after vaccination to be inspected, and shall not render a reasonable excuse for his neglect, shall be guilty of an offence, and be liable to be proceeded against summarily, and upon conviction to pay a penalty not exceeding 20s.' This clause was in substance a 85 re-enactment of the clause in the Act of 1853 (section 9) upon which the case of Pilcher v. Stafford was decided, but it is important to refer to it again in connexion with the changes of the law contained in other sections of the Act. A point of some importance has been raised with reference to the construction of section 29. |
e02ab8e7-43c9-4a51-9571-8a51266f6e95 | It will be observed that it provides that every parent or person having the custody of a child who neglects to have the child vaccinated ' and shall not render a reasonable excuse for his neglect' shall be guilty of an offence and be liable to be proceeded against, and upon conviction to pay a penalty. It has been contended that this points to the reasonable excuse being rendered before proceedings are taken. There is much to be said for this contention. The parent ' guilty of an offence' and ' liable to be proceeded against' is one who neglects and shall not render a reasonable excuse for his neglect. The section does not say that the parent who, without reasonable excuse, neglects to have his child vaccinated, shall be guilty of an offence, as one would expect if the intention were that the excuse should be rendered to the magistrate as a defence when proceedings have been instituted. The section is certainly so framed as to afford countenance to the contention we are considering. |
ecd5ff10-919e-4633-9ebb-6bb7d9465ffd | On the other hand, no body or person is indicated to whom an excuse can be rendered before the proceedings are instituted. There is no machinery provided for hearing and adjudicating upon excuses at that period and for giving a certificate that a reasonable excuse has been rendered to serve as a bar to further proceedings. On the whole, then, although it is not for us to express an opinion on the legal construction of the clause, which is very unhappily framed, it would probably be construed as intending that the excuse should be rendered to the tribunal before which proceedings for the neglect to vaccinate are pending. We now come to the much-discussed section 31. It seems probable that section 31 was enacted for the very purpose of supplementing the provisions of section 29. |
0c399726-8497-42b8-9474-e030908154a0 | Its purpose seemed to be to enable those who prosecuted (and this duty had by 86 section 27 been imposed upon the Guardians) to follow the parent responsible for the vaccination so long as the child remained unvaccinated, and by penalties to compel the parent to do what, according to the law, was his duty. Nevertheless, no conviction could take place under this section without a previous order of a magistrate, and the first step in the transaction was to inform the magistrate and obtain a summons to the parent to appear with the Ghild before him. Thereupon, when the parent appeared absolute discretion was left to the magistrate before whom the case was brought. He might or might not make the necessary order. If he did not, no further penalty could be inflicted. If he did, and it was obeyed, no penalty could follow. But if he did, and it was disobeyed, one penalty alone could be inflicted for the disobedience. |
a2bd9617-411f-473f-abe7-e5048008e4a8 | A further order must be made, and that order disobeyed before another penalty—not for disobedience to the first—but to the second order, could be inflicted. This is evident from the words of the section. The magistrate ' may, if he thinks fit'—words of absolute discretion—make an order for vaccination ; and there is nothing in the section to bind the magistrate's discretion to refrain from making an order should he for any reason come to the conclusion that it was expedient to do so. The words of the section seem purposely framed to leave the discretion to the magistrate. It is true that if the order was once made and disobeyed, without the justification of one or other of the two matters of excuse mentioned in the section, the disobedience must be punished and the parent prosecuted (the words are ' shall' be proceeded against), but the discretion was to be exercised before the order was made, and this discretion is left to the magistrate. |
30a03c08-5b84-4eb9-ae7b-68c16ee49e01 | Accordingly it was held in the case of Allen and Worthy, reported L.R. 5, Q.B. 163, that, notwithstanding the principle laid down in Pilcher v. Stafford a second conviction could follow disobedience to a second order under the section just referred to. Lord Chief Justice Cockburn said, ' I think that the intention of the Legislature was not simply that a penalty should be imposed 87 on a person once for all if he omitted to do that which, in the view of the Legislature, public health and safety required, but that a penalty might be imposed so long as disobedience to its enactments continued. I, therefore, hold that the powers given by section 31 are not confined to one order and one conviction, but that the proceedings may be repeated toties quoties so long as disobedience continues.' |
6f0a868c-c222-4850-b08a-2b69609a1cc9 | There is no doubt that those magistrates who, in the exercise of their discretion, made repeated orders in respect of the same child, were, in the opinion of many, mistaken, and harsh results often followed, and the evidence of this, which was brought before them, doubtless led to the recommendation in the Report (dated 23rd May, 1871) of the Select Committee of the House of Commons on the Vaccination Act (1867), that no more than two penalties or one full penalty should be imposed in respect of the same child. The Act of 1867 remained unaffected by subsequent legislation until the 1st January, 1872, when the Vaccination Act, 1871, came into force. Meanwhile a Select Committee had been appointed to inquire into the working of the Act of 1867, and this Act of 1871 was introduced into the House of Commons by Mr. Forster, its chairman. |
b91fdc6f-fdd4-4f00-b970-17c2e8d57ba4 | The Act was entitled ' an Act to amend the Vaccination Act, 1867,' and was to be construed as one with it. A change of importance was made by the fifth section which rendered the appointment and payment of officers to prosecute and to enforce the provisions of the Acts obligatory upon the Guardians, whereas it had theretofore been permissive only. These officers were to be called Vaccination Officers. They were to perform all the duties imposed on the Registrars by the principal Act, except giving the notices to the parents within seven days of the registration of the births under section 15 of the Act of 1867. 88 By section 8 it was provided that every Registrar of Births and Deaths for any place should once at least transmit to each Vaccination Officer a return of all births and deaths of infants under twelve months of age, which, since the date of the last return had been registered by him. Section 9 deals with re-vaccination. |
df952eac-2fb2-4b4c-a5dc-7fa0a15a911c | It enacts that when the operation of re-vaccination is performed gratuitously by a Public Vaccinator on the application of any person, he shall deliver to such person a notice requiring him to attend for inspection, and if that notice is not complied with such person is rendered liable to pay to the Guardians a fee of 2s. 6d. Section 10 imposes a fine of 20s. on any person who prevents a Public Vaccinator taking lymph from any child as provided by section 17 of the principal Act. Section 11 imposes a similar penalty on any parent who fails to produce a child when required by summons under section 31 of the principal Act. By the same section any complaint may be made and any information laid at any time not exceeding twelve months from the time when the matter of complaint or information arose, and not subsequently. This is a new provision as to limitation. |
262d315f-cd68-49f1-b906-3896b401bef4 | There is a further provision as to re-vaccination in section 13 granting fees to the medical officer of the Union if, while attending as such medical officer upon a Small-Pox patient, he either (1) vaccinates a person who has never been vaccinated or had Small-Pox, or (2) re-vaccinates any person who is resident in the same house with the person sick of the Small-Pox, and has never been re-vaccinated, being of the age at which public re-vaccination is paid for to a Public Vaccinator under the regulations for the time being of the Privy Council. By the joint effect of the Vaccination Act, 1874, the fifth section of the Vaccination Act, 1871, and the Local Government Act, 1871, |
f269fac1-320b-4843-8f40-aa3aca76cf9e | the Local Government Board was clothed with the same powers with respect to the Guardians and Vaccination Officers in matters relating to vaccination as the Poor Law 89 Board possessed with regard to Guardians and Officers of Guardians in matters relating to the relief of the Poor, and had power to make rules and regulations, and it was enacted that all enactments relating to such powers and to such orders, rules, and regulations by the Poor Law Board should apply, mutatis mutandis, to the Local Government Board, including rules, orders, and regulations prescribing the duties of Guardians and their Officers in relation to the institution and conduct of the proceedings to be taken for enforcing the provisions of the Vaccination Acts of 1867 and 1871, and the payment of the costs and expenses relating thereto; and rules, orders, and regulations under the Act of 1874 were to be deemed to be made under section 5 of the Act of 1871. |
c98cf586-d49e-466d-b756-130703297d0d | By the machinery thus introduced, provision was made in substitution for that contained in the 27th section of the Act of 1867, which was repealed by the Act of 1871; that section, as has been pointed out, imposed upon the Guardians the duty of prosecuting cases brought to their knowledge by the Registrar. The new machinery gives power to the Local Government Board to regulate this matter among others, and they have acted on this power. The Bill, as introduced by Mr. Forster, the Chairman of the Select Committee, contained a clause (1) so framed as to carry out the recommendation in the Report as to repeated prosecutions in the case of the same child. This was struck out in the House of Lords, the amendment being carried by eight votes against seven. When the Bill was returned to the Commons Mr. Forster, at that period of the session, felt compelled to accept the amendment, being anxious to pass the Bill. |
7146d331-e919-406c-bb3b-283026df4e78 | One other point remains for notice arising under the Act of 1871. It is provided by section 11 that the defendant in any proceedings under the Acts of 1867 and 1871 may appear by any member of his family, or by any person authorised by him in that behalf. 90 Such are the provisions of the Acts which have from time to time been passed with direct reference to the subject of vaccination. The legislation is founded on the assumption of its efficacy, and that its advantages are so manifest that it is the duty of the State to enforce it even by the imposition of penalties for its neglect. It is obvious that the most important part of the work rests with the public authorities, to whom the vaccination of the population has been entrusted, subject to the general control of the central authority. Details of the mode in which the vaccination law of Scotland is administered will be found in the evidence of Mr. John Skelton, then Chairman of the Board of Supervision. |
91d9fc7b-9274-4280-ba01-54a8d36aae9f | Both the statute law and the method of administration differ very materially from those which prevail in this country. Some of the points of difference in the two systems have so material a bearing upon questions submitted to us for report that it will be well here to call attention to them. An official vaccinator is appointed by each Parochial Board. Beyond the vaccination of paupers and the children of paupers, however, his duty is confined to vaccinating defaulters. The great majority of vaccinations in Scotland are performed by private medical practitioners at the expense of the parent or guardian. In all cases in which certificates are not received by the Registrar of compliance with the requirements of the Act, the names are inserted in a list of defaulters sent every six months to the Parochial Board. It then becomes the duty of that Board to see that these defaulters are vaccinated. |
d5546b7c-2079-4a36-911b-ddee00ed2209 | They go through the list transmitted to them, and notify to the parent or guardian of each child that its name is contained in the list, and that if not privately vaccinated it will be vaccinated by the official vaccinator. The Parochial Board issue an order to the vaccinator to vaccinate the persons named in the list not less than 10 days nor more than 20 after the date of the notice to the parent or guardian. A large number of the defaulters are 91 privately vaccinated in consequence of these notices before the visit of the official vaccinator. If this has not been done the vaccinator calls on each of the defaulters and offers to vaccinate. If the parent's consent is obtained the child is vaccinated; if consent is refused, a certificate is given stating the fact and the ground of refusal. Any other reason for not vaccinating a child such as insusceptibility, previous vaccination, or condition of health, is also embodied in a certificate. |
5b562c91-270b-4ae2-a2ce-76f8b94bb861 | The power conferred upon local authorities under the Public Health Act by section 57 of that Act to afford gratuitous vaccination appears to be exercised chiefly when epidemics are present within the district of the local authority. A house-to-house visitation is often made by medical men appointed for the purpose, and a large number of re-vaccinations are thus effected. The distinguishing feature of the Scotch system which deserves special attention is that the operation is carried out in almost all cases at the house where the vaccinated person is residing. The official vaccinator visits the case there after an interval of eight days to see whether the operation has been successful. Although he pays no visit in the interval, he would often be sent for if any untoward symptoms presented themselves, inasmuch as the official vaccinator is in ninety-nine cases out of a hundred the officer whose duty it is to afford medical assistance to the poor. |
b1165b17-7761-46ea-863d-d4b7ddc4fc11 | These details are here given, because it has been proposed that the method of securing vaccination in England be assimilated to that adopted in Scotland. It must be remembered that the populations of large English Cities cannot be rendered so favourably disposed to domicilliary visits by the public vaccinator as in the more sparsly populated'districts in Scotland, where nearly every person would be known personally by the public vaccinator. The following table shows the mortality from SmallPox in England and Wales during each of the years in 1838-1842 and 1847-1894. The figures for the years 1843-1846 are not available. z6 Mortality from Small Pox in England and Wales during years 1838-42 and *1847-94. (The figures for the years 1843-46 are not available). Year. Population. Number of Deaths from Small-Pox (with those returned as from Chicken-Pox). |
094c51b6-52dd-4ff4-a8d4-94c98fc7b546 | Deaths from Small-Pox (with those returned as from Chicken-Pox) to every 100,000 living. Year. Population. Number of Deaths from Small-Pox (with those returned as from Chicken-Pox). Deaths from Small-Pox (with those returned as from Chicken-Pox) to every 100,000 living. |
657cac24-746b-4856-8c2a-59dc04833ab1 | 1838 15,287,699 16,268 106 1867 21,677,525 2,513 12 1839 15,514,255 9,131 59 1868 21,948,713 2,052 9 1840 15,730,813 10,434 66 1869 22,223,299 1,565 7 1841 15,929,492 6,368 40 1870 22,501,316 2,620 12 1842 16,130,326 2,715 17 1871 22,788,594 23,126 102 1843 16,332,228 Causes of death not abstracted by Registrar-General. 1872 23,096,495 19,094 82 1844 16,535,174 1873 23,408,556 2, |
e11f16cb-96b4-4bce-a757-8fd61dad10ee | 364 10 1845 16,739,136 1874 23,724,834 2,162 9 1846 16,944,092 1875 24,045,385 952 4 1847 17,150,018 4,227 25 1876 24,370,267 2,518 10 1848 17,356,882 6,903 40 1877 24,699,539 4,395 18 1849 17,564,656 4,644 26 1878 25,033,259 1,970 8 1850 17,773,324 4,665 26 1879 25,371,489 631 3 1851 17,982,849 6,997 39 1880 25,714,288 754 3 1852 18,193,206 7, |
1e34def7-8180-4489-9148-092c4c3ab49a | 320 40 1881 26,046,142 3,231 12 1853 18,404,368 3,151 17 1882 26,334,942 1,439 5 1854 18,616,310 2,808 15 1883 26,626,949 1,056 4 1855 18,829,000 2,525 13 1884 26,922,192 2,363 9 1856 19,042,412 2,277 12 1885 27,220,706 2,936 11 1857 19,256,516 3,936 20 1886 27,522,532 368 1 1858 19,471,291 6,460 33 1887 27,827,706 593 2 1859 19,686,701 3, |
bae5ce0a-748e-4ecd-8210-6b793ec33fd4 | 848 20 1888 28,136,258 1,142 4 1860 19,902,713 2,749 14 1889 28,448,239 106 .4 1861 20,119,314 1,320 7 1890 28,763,673 111 .4 1862 20,371,013 1,628 8 1891 29,082,585 140 .5 1863 20,625,855 5,964 29 1892 29,405,054 554 2 1864 20,883,889 7,684 37 1893 29,731,100 1,584 5 1865 21,145,151 6,411 30 1894 30,060,763 928 3 1866 21,409,684 3, |
6ee9e353-7ef6-4177-b274-805c249e33a4 | 029 14 93 Mortality from Small-Pox in London during years 1838-94, including deaths in Metropolitan Asylum Board Ships (outside Metropolis) for the last 11 years. Year. Population. Number of deaths from Small-Pox. Deaths from Small-Pox to every 100,000 living. Year. Population. Number of Deaths from Small-Pox. Deaths from Small-Pox to every 100,000 living. 1838 1,766,169 3,817 216 1867 3,085,971 1,345 44 1839 1,802,751 634 35 1868 3,131,160 597 19 1840 1,840,091 1,235 67 1869 3,176,308 275 9 1841 1,878,205 1,053 56 1870 3,221, |
84d5d14a-792f-4127-be07-c72ce2a968a3 | 394 973 30 1842 1,917,108 360 19 1871 3,267,251 7,912 242 1843 1,954,041 438 22 1872 3,319,736 1,786 54 1844 2,033,816 1,804 89 1873 3,373,065 113 3 1845 2,073,298 909 44 1874 3,427,250 57 2 1846 2,113,535 257 12 1875 3,482,306 46 1 1847 2,202,673 955 43 1876 3,538,246 736 21 1848 2,244,837 1,620 72 1877 3,595.085 2,551 71 1849 2,287, |
778bf3a1-91d8-4d86-8e2a-9e2fac58e765 | 302 521 23 1878 3,652,837 1,417 39 1850 2,330,054 499 21 1879 3,711,517 450 12 1851 2,373,081 1,062 45 1880 3,771,139 471 12 1852 2,416,367 1,159 48 1881 3,824,980 2,367 62 1853 2,459,899 211 9 1882 3,862,956 430 11 1854 2,503,662 694 28 1883 3,901,309 136 3 1855 2,547,639 1,039 41 1884 3,940,042 1,236 31 1856 2,591,815 531 20 1885 3,979,160 1, |
7b3f23a6-aefa-4977-a581-9962909c7d60 | 419 36 1857 2,636,174 156 6 1886 4,018,666 24 .6 1858 2,680,700 242 9 1887 4,058,565 9 .2 1859 2,725,374 1,158 42 1888 4,098,860 9 .2 1860 2,770,181 898 32 1889 4,139,555 0 0 1861 2,815,101 217 8 1890 4,180,654 4 .1 1862 2,860,117 366 13 1891 4,222,157 8 .2 1863 2,905,210 1,996 69 1892 4,264,076 41 1 1864 2,950,361 547 18 1893 4,306, |
c42471d3-b3a9-4f8d-9335-8a212f8efafb | 411 206 5 1865 2,995,551 640 21 1894 4,349,166 89 2 1866 3,040,761 1,39I 46 94 In order to make the figures in the above table comparable throughout, we are obliged to include with the deaths returned as from Small-Pox those returned as from Chicken-Pox, the Registrar-General not having distinguished between such returns in his abstracts for the years 1838-1842 and 1847-1854. In this connexion, however, the inclusion or exclusion of deaths returned as from Chicken-Pox makes no material difference ; the number of deaths at all ages so returned being but small, in comparison with the deaths at all ages returned as from Small-Pox, except as regards the years 1889, 1890, and 1891, when the Small-Pox mortality was very small. |
c1e56415-ed4e-4a07-8d99-4d498da36255 | Had the number of deaths returned as from Chicken-Pox been large enough to affect to any material extent the figures in the table, we should have excluded these deaths so far as we were able, though we think it possible and even probable that some of them may have been mistaken cases of Small-Pox. It is highly improbable that the number of such cases was considerable, seeing that, since deaths from Chicken-Pox have been separately recorded, the number of them has been small and approximately the same, year by year, whether Small-Pox was prevalent or not. There exist no figures, comparable throughout the period 1838-1894, by which we can measure the extent to which, at one time as compared with another, the practice of vaccination prevailed in England and Wales in those years. That there has been, speaking generally, during that period a large spread of the practice is beyond doubt. |
d1c81714-24b8-413b-9d49-3e969ef02bfb | We have given an account of the legislation from time to time enacted to this end, and we shall therefore merely recapitulate 95 here the dates of the principal Acts of Parliament relating to the practice of vaccination in England and Wales which have come into force during this period. In 1840-1 the means of vaccination was provided at the expense of the Poor Rates for every person in England and Wales. In 1853 the practice of vaccination was made compulsory in regard to children born in England or Wales after the 1st August, 1853, and penalties were imposed for noncompliance. The provisions for this purpose then enacted were found in working to be very imperfect; and, indeed, the obligation to be vaccinated remained little more than nominal down to the date of the appointment of paid Vaccination Officers. At the same time, however, the fact that the law required vaccination within a prescribed period from birth no doubt increased the spread of the practice. |
604ae7ae-057e-48d1-a57f-612584960c67 | In 1867, the laws relating to vaccination in England and Wales were consolidated and amended ; and the provisions then enacted, as regards those Unions where the power given to appoint paid Vaccination Officers was exercised, were such as to make effective the obligation to be vaccinated. In many Unions, however, this power was not at once exercised. From the evidence taken by the Select Committee of the House of Commons in 1871, it appears that of 260 Unions inspected by the Medical Department of the Privy Council in the course of the year 1870, two years and more after the Act of 1867 had come into force, 121 were reported as not having at the date of inspection appointed 96 Vaccination Officers, and 127 as having made such appointments, there being no report on the point as to the remaining 12 Unions (Appendix No. 15 to the Committee's Report); and in May, 1871, Dr. |
e9d637dc-f78d-4988-8fed-2b2e51424c38 | Seaton informed the Committee that there were still a great many Unions in which Vaccination Officers had not been appointed (Question 5,499). In 1871 the Act of 1867 was amended by making the appointment of paid Vaccination Officers compulsory in all Unions, by simplifying and improving the arrangements for the registration of vaccination, and in other ways. The effect of the amending Act towards increasing the spread of vaccination would be thus more marked in Unions where the power to appoint paid Vaccination Officers had not before its enactment been exercised ; but the amendment of the law as to the registration of vaccination was such as to render it, in every Union, less likely that the obligation to be vaccinated would be evaded. The records kept under the Vaccination Act of 1871, and tabulated by the Local Government Board, show the amount of primary vaccination performed within a certain period of birth, of children whose births were registered in England or Wales during the years 1872-1893. |
7aa86b48-b5aa-46bd-841d-a08c63f53bc2 | The following table gives the figures:— Year. Births registered during Year. Of the Children whose Births were registered during the Year given in the First Column, by the 31st January in the Year next but one following that Year there were: Successfully vaccinated. Certified as insusceptible of Vaccination. Had Small-Pox. Died unvaccinated. Vaccination postponed by Medical Certificate. Remaining The Children not finally accounted for (including cases postponed) being Per Cent. of Births. 1872 821,856 698,137 1,693 905 78,594 42,527 5.1 1873 826,508 704,666 942 86 80,512 4,264 36,038 4.8 1874 854,787 727,065 920 96 85,325 5,677 35,704 4.8 1875 850, |
7d8f9db9-1f80-4a24-89a5-a5198d9b9489 | 354 722,466 838 38 86,673 5,914 34,425 4.7 1876 887,694 763,277 848 107 84,930 5,528 33,004 4.3 1877 887,947 766,824 926 118 79,497 6,681 33,901 4.5 1878 891,743 760,982 840 44 87,936 6,475 35,466 4.7 1879 880,222 756,835 742 26 78,478 6,670 37,471 5.0 1880 881,652 750,203 859 46 87,361 5,930 37,253 4.9 1881 883,744 765,162 1,017 81 77,471 6,302 33, |
c732f811-8fab-4a47-b071-fcd1b718ada5 | 711 4.5 1882 889,082 763,525 993 45 81,498 7,598 35,423 4.8 1883 890,780 762,080 1,012 93 81,955 8,110 37,440 5.1 1884 906,581 764,975 1,363 81 90,134 8,693 41,335 5.5 1885 894,263 757,714 1,278 42 83,686 9,323 42,220 5.8 1886 903,846 754,059 1,278 20 90,774 10,187 47,528 6.4 1887 886,198 733,980 1,556 27 87,827 10,402 52,406 7.1 1888 879,813 719, |
ccd24186-f276-4385-9e56-288c9b9b26f7 | 103 1,888 12 83,287 12,282 62,701 8.5 1889 885,909 707,l6l 1,758 2 88,995 13,366 74,627 9.9 1890 875,188 682,560 1,672 2 91,768 13,615 85,571 11.3 1891 914,079 693,117 1,806 9 96,351 13,823 108,973 13.4 1892 890,695 663,657 1,983 26 92,490 13,278 119,261 14.9 1893 914,557 661,513 3,394 39 102,442 13,845 133,324 16.1 L6 98 From these figures it may be inferred that, |
8c7f29d0-494d-4c19-860c-16d1b10e0171 | as regards those children whose births were registered during each of the years 1872-1883, the proportion primarily vaccinated remained practically the same. The effect of the opposition to the practice of vaccination, which in some parts of the country has grown of recent years (though to some extent at all events it has existed in England during the whole period now dealt with), is shown by the gradual diminution of the proportion primarily vaccinated in the case of children whose births were registered in England or Wales during each of the ten years 1884-1893. The diminution of this proportion did not, of course, necessarily result at once in a diminished proportion of the population who had, at some time in their lives, been vaccinated. The materials before us do not allow us to make any numerical statement of the proportion, as time went on, during the period 1838-1894, of the population of England and Wales who had at some time been vaccinated. |
2ba916ad-42d3-46a4-a3bb-69593d817768 | So far as we can judge of the effect of the efforts made during that period to extend the practice of vaccination, the proportion of the population who had at some time been vaccinated has steadily grown, though with no even rate of increase, during the years from 1840 onwards, down to a recent date at all events. The rate of increase was greater in 1853, and the few years immediately following it, than in previous years, and again expanded, still more considerably, in the years from 1868 to 1872, and perhaps in some few succeeding years. Speaking generally of the period since 1838, there has been, as the table given on p. 000 clearly shows, a marked though irregular decline in the death-rate from small-pox. It may be well, too, to note at once a striking feature of this decline. |
def56860-ab88-40c9-a173-c694f249278b | During the period 1838-1894 the decline in the death-rate at all ages from Small-Pox has not been shared alike by the population at every age. While the decline in the deathrate of the population under ten years of age has been even more 99 marked than the decline shown by the table in p. ooo in the death-rate at all ages, there has been amongst the population over ten years of age a far less marked decline or, at certain of the higher ages, an actual increase in the death-rate. We shall have presently (pp. ooo-ooo) to discuss fully this question of the altered age incidence of fatal Small-Pox, both in England and Wales and in Scotland and Ireland. We have dealt so far with the evidence afforded by the statistics of the mortality from small-pox at different epochs in view of the spread or continued practice of vaccination. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.