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The Vaccination Act, 1898.—The principal sections of this Act arc set out in
Part VI., under the head of Legislation. The points are briefly, that the period for
infant vaccination is extended from three to six months, that Public Stations are
abolished, and Public Vaccinators are to visit and vaccinate children in their own
homes, that the infants of certificated conscientious objectors are exempted, that
the penalties and punishments are mitigated, and that the Local Government
Board may make Pules and Regulations as to Public Vaccinators.
They have accordingly ordered that Public Vaccinators shall use only
glycerinated calf lymph or such other lymph as the Local Government Board
may issue.
The most pressing question, however, and one not touched either by the new
Act, or by the new General Order, is that of the standard of vaccination.
Standard of Vaccination.—In the Amended Regulations of the Local Government
Board General Order, dated 18th October, 1895, Third Schedule, Instructions
to Vaccinators under Contract (that is, Public Vaccinators), the standard of
vaccination is set out in Instructions 7 and 8.
"(7) In all ordinary cases of primary vaccination the Public Vaccinator must
aim. at producing four separate good-sized vesicles, not less than half an inch from
one another. The total area of vesiculation resulting from the vaccination should
not be less than half a square inch."
"(8) * * * * In cases of successful primary vaccination the
Public Vaccinator must record the number of separate scarified areas, punctures, or
groups of punctures made, and the number of separate normal vaccine vesicles or
groups of vesicles which have been produced. In case of re-vaccination he must
register as "successful" only those cases in which either vesicles, normal or
modified, or papules surrounded by areolce have resulted."
Unfortunately these Instructions do not apply to oilier than Public Vaccinators,
and Private Vaccinators have only to certify that a child has been ''successfully
vaccinated." A District Medical Officer has elicited from the Local Government
Board the meaning of the words "successfully vaccinated," in a letter dated from
Whitehall, 12th November, 1898, and published in the British Medical Journal
19th November, 1898, to the following effect:—"The Board are of opinion that the
performance of vaccination in such a way as to only produce one or two vaccine
vesicles is much to be deprecated, and that such vaccination affords less protection
against smallpox than when done in accordance with the instructions issued to
Public Vaccinators. It appears to the Board, however, that for the purposes of
their regulations a person who has on him the distinct mark of one vaccine vesicle
must be deemed to have been successfully vaccinated." It is, therefore, clear that
the minimum results of distinct vaccination, affording little or no protection, rank
as successful vaccination as the maximum results, affording the maximum protection
of immunity.
A certificate of successful vaccination is justified by the appearance of the
smallest vesicle, and tender-hearted mothers who can afford it secure this result,
and yet satisfy their consciences by avoiding the Public Vaccinator and making the
practice of the Private practitioner depend upon the present production of the least
discomfort to the child.