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Vaccination Law.—Small-pox, almost non-existent in the County of London last year,
prevailed, though not to any great extent, in certain parts of the North of England. The town of
Dewsbury, in the West Riding of Yorkshire, suffered more, perhaps, than any other locality, and
acquired an unenviable notoriety through the ineptitude of its sanitary authority in regard to the
means of isolation for the sick, and of its Poor Law authority in regard to vaccination—the
guardians having " refused to aid the administration of vaccination, by opening stations at which
vaccination and re-vaccination could be performed expeditiously, conveniently, and economically."*
But out of evil good came, the Local Government Board, after almost incredible patience, having
issued an Order— "Dewsbury (Small-pox Prevention) Order, 1904"—which imposed the
administration of vaccination upon the Corporation ; and, furthermore, the Board, by virtue of the
powers which they possess under the provisions of sections 130 and 134 of the Public Health Act,
1872, and of the Public Health Act, 1896, issued regulations for the prevention of small-pox, which
entitled the Medical Officer of Health to vaccinate and re-vaccinate any person in immediate danger
of contracting small-pox, and placed the Corporation under an obligation, forthwith to provide a
"vaccination centre" for the performance of vaccination and re-vaccination, and to provide such
other "centres" as the Medical Officer might deem necessary. For each such " centre" the
Corporation were required to employ a medical practitioner to vaccinate and re-vaccinate; the
public vaccinator, however, not being superseded if willing to accept employment under the
Corporation. The Order is thus seen to be comprehensive, in regard to the provisions for securing
vaccination and re-vaccination, the only means whereby an epidemic can be quickly and effectively
brought to a close. "Two special small-pox officers (it may be added) were appointed, one to take
charge of the small-pox hospital, and the other to deal with contacts and other matters."+
I refer to the subject to show that the Local Government Board have powers for dealing
effectively with a recalcitrant vaccination authority, powers which, in the interests of public health,
it is to be desired that they may in future exercise at an earlier date than in the case of Dewsbury,
which had been acting for a long time as a centre for the spread of small-pox to other districts.
London was by no means uninterested in the matter, a small outbreak of small-pox at Willesden
having been attributed to importation of a case from Yorkshire.
The action taken by the Local Government Board in this instance is likely to be of historical
interest, it being, apparently, the first exercise of their latent and apparently sufficient powers in this
regard.
THE METROPOLITAN ASYLUMS BOARD.
Under the provisions of the (now repealed) Sanitary Act, 1866, the local sanitary authority
was endowed with power to provide, for the use of the inhabitants of their district, hospitals for the
reception of the sick ; a provision re-enacted in section 75 of the Public Health (London) Act, 1891.
But, excepting in a few districts, and for a limited period in time of emergency; e.g., when smallpox
was epidemic, this power was not exercised, despite official pressure brought to bear to induce
sanitary authorities to erect local hospitals. The late Vestry led the opposition to the establishment
of such hospitals, with little support at first, but ultimately with complete success ; and no one
now doubts that the policy of that body was wise, and fruitful of benefit to the entire Metropolis.
In 1867 the Metropolitan Poor Act brought the Asylums Board into existence, and this body set to
work forthwith to provide infectious disease hospitals, nominally for paupers only. As a matter of
fact, however, and despite the disabilities attaching, in theory, to the use of the hospitals, they were
largely used from the beginning by non-paupers; and in course of time legislation secured to the
inhabitants of the Metropolis all of the advantages contended for by the late Vestry, at my instance,
from 1877 onwards. The hospitals are now free to all, no disability attaching to the use of them.
The Managers, as the central authority, have fulfilled their duties admirably, and have created for
London a hospital system unequalled elsewhere, and which, it is perhaps not too much to say, is
the admiration of foreign nations. Be this as it may, the Managers fulfil the duties originally
devolving upon the local sanitary authorities; duties which those authorities would undoubtedly
have had to perform but for the creation of the Board, and the subsequent legislation which has so
enhanced their power as to leave little to be desired. Details of the work of the Managers as
hospital and ambulance authority in respect to infectious disease, are set out in an annual report,
which (for 1904) had not been published when this report went to press.
* The Lancet, October 29th.
† The British Medical Journal, November 12th.