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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. 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.
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.