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11
Of the deaths registered under the last -named headings, I have strong reason
to believe, from enquiries made in reference to them, that 11, if not more, were
due to a masked form of Scarlatina; so that the deaths from Diphtherite are
reduced to 36. It will be noticed that the deaths have not been most numerous
in those sub-districts which have the highest mortality, but that in Tottenham
Court and Gray's Inn, which stand highest in the scale of mortality, the deaths
from this disease have been fewest. In examining the houses and streets where
the deaths have occurred, both from Scarlatina and from Diphtherite, it is not
very obvious, in most cases, on what external conditions, if upon any, the
fatality of the disease was dependent.
As an illustration of the manner in which infectious diseases may be spread
from the poor to the rich, I may mention that during last year in the course of
my inspections, I met with a woman living in a garret, occupied by herself and
several children, who were suffering from Small Pox. This poor woman was
employed in making up a handsome silk dress, which was designed for the back
of some young lady, who would thus probably contract the loathsome disease,
and might communicate it to a number of her companions.
During the year there have been 22 deaths from Small Pox, nearly all of
unvaceinatcd persons; in 1857 there were only 11 deaths. There is reason to
fear that the practice of vaccination is still very much neglected. From a return
recently obtained by the Registrar-General from the District Registrars, it
appears that whilst 6314 births were registered in St. Pancras in one year, only
3695 certificates of vaccination were received ; whereas, by the law, all vaccinated
children ought to be certified as having been vaccinated. This great
difference between the number of births and the number certified to be vaccinated
depends on a combination of causes; first, about 400 children die under
the age of 3 months at which age vaccination is usually performed; secondly,
many medical men who vaccinate children, in fact, nearly all who are not
public vaccinators, and some even of the latter class, fail to send the certificate
to the Registrar; nor is this to be wondered at seeing that they have no compensation
for so doing; then thirdly, very many children are not vaccinated at
all, owing either to ignorance, prejudice, or apathy on the part of those who
have charge of them. The registration of a birth is not compulsory, and is not
always attended to; where this is omitted the parents receive no authoritative
information as to the necessity of having it vaccinated. With the present very
incomplete system of registering vaccination, it is very difficult to get evidence
of its non-performance, so that the penalty may be enforced. Further, it is not
any one's special business to undertake the prosecutions under this A.ct, although
by the Public Health Act, 1858, it is provided that " Proceedings for Penalties,
under the Acts for time being in force on the subject of Vaccination, may be
taken on the complaint of any Registrar employed for the Registration of Births,
Deaths, and Marriages, Public Vaccinator, or Officer authorised by the Board of
Guardians, or by the Overseers respectively; and the cost of such proceedings
shall be defrayed out of the Poor Rates." But although the Registrars and
Public Vaccinators may institute proceedings for the recovery of these penalties,
yet there is no inducement for them to do so, unless they are actuated entirely
by public spirit. The consequence of all this is, that the so-called Compulsory
Vaccination Act is almost a dead letter. It requires very great amendment to
make it of much practical utility. The more general adoption of Vaccination
must, however, be brought about in other ways than by direct compulsion,
which is contrary to the spirit of the English laws, and should only be adopted
in extreme cases. If the circumstance of having been successfully vaccinated,
or of having had the Small Pox, were an essential condition to the entry of all
public or private schools, or to the obtaining any appointments in the public
scrvice, and if employers would ascertain before engaging servants whether