London's Pulse: Medical Officer of Health reports 1848-1972

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London County Council 1896

[Report of the Medical Officer of Health for London County Council]

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most thorough. We think it may fairly be concluded that where the vaccine matter is inserted in three
or four places, it is more effectual than when introduced into one or two places only and that if the
vaccination marks are of an area of half a square inch, they indicate a better state of protection than if
their area be at all considerably below this.
In respect to the risks of vaccination the Commission reports—
(434.) A careful examination of the facts which have been brought under our notice has enabled us
to arrive at the conclusion that, although some of the dangers said to attend vaccination are undoubtedly
real and not inconsiderable in gross amount, yet when considered in relation to the extent of vaccination
work done they are insignificant. There is reason further to believe that they are diminishing under the
better precautions of the present day, and with the addition of the further precautions which experience
suggests will do so still more in the future.
On the value of isolation in replacement of vaccination the Commission thus expresses itself—
(503.) We can see nothing then to warrant the conclusion that in this country vaccination might
safely be abandoned and replaced by a system of isolation. If such a change were made in our method
of dealing with smallpox, and that which had been substituted for vaccination proved ineffectual to prevent
the spread of the disease (it is not suggested that it could diminish its severity in those attacked) it is
impossible to contemplate the consequences without dismay.
To avoid misunderstanding it may be well to repeat that we are very far from underrating the value
of a system of isolation, we have already dwelt upon its importance. But what it can accomplish as an
auxiliary to vaccination is one thing, whether it can be relied on in its stead is quite another thing.
Among the opinions expressed relating to changes in administration are the following—
(437.) That parents should not be required to submit their children to vaccination by means of any
but calf lymph, but this should not preclude the use of humanized lymph in case they so desire.
(438.) That it would be well, at all events, to extend the age period in England and Wales and in
Ireland (within which vaccination is obligatory) to six months from the date of birth.
(443.) If children were vaccinated and inspected as a rule at their own homes instead of being
brought to a public station, we believe the risk of injury would he sensibly lessened.
The following paragraphs indicate the opinion of the Royal Commission on the question of
(524.) After careful consideration, and much study of the subject, we have arrived at the conclusion
that it would conduce to increased vaccination if a scheme could be devised which would preclude the
attempt (so often a vain one) to compel those who are honestly opposed to the practice to iiubmit their
children to vaccination, and, at the same time, leave the law to operate, as at present, to prevent children
remaining unvaccinated owing to the neglect or indifference of the parent. When we speak of an honest
opposition to the practice, we intend to confine our remarks to cases in which the objection is to the
operation itself, and to exclude cases in which the objection arises merely from an indisposition to
incur the trouble involved. We do not think such a scheme impossible.
(525.) It must of course be a necessary condition of a scheme of this description, that it should be
such as would prevent an objection to the practice being alleged merely as an excuse to save the
trouble connected with the vaccination of the child. We may give the following as examples of the
methods which might be adopted. It might be provided that if a parent attended before the local
authority, and satisfied them that he entertained such an objection, no proceedings should be taken
against him. Or, again, a statutory declaration to that effect before any one now authorised to take
such declaration, or some other specified official or officials, might be made a bar to proceedings. We
do not think it would be any real gain to parents who had no conviction that the vaccination of their
children was calculated to do mischief, to take either of these steps rather than submit them to the
The subject of re.vaccination is thus referred to—
(533.) We have already adverted to the importance which we attach to re.vaccination. It has been
suggested that the operation should be made compulsory by law. Wo are quite alive to the protective
value of general re.vaccination. At the same time we are not insensible of the difficulties necessarily
involved in rendering it compulsory. It is, comparatively speaking, easy in the case of infants to
ascertain whether the law requiring vaccination has been complied with. The constant movement of
the population would render it much more difficult to ascertain whether at the more advanced age at
which it would become applicable, a law providing for compulsory re.vaccination had been observed.
Again, it is impossible to leave out of sight the effect that such an extension of the present compulsory
law might have in intensifying hostility, where it at present exists, and even in extending its area ; though
if our recommendations, especially that which exempts from penalty those who honestly object to the
practice, were adopted, this objection would be much diminished. After full consideration of the question
we are, however, deterred by the considerations to which we have adverted from proposing that
re.vaccination should be made compulsory. At the same time, in view of the great importance of
re.vaccination, we think it should be in every way encouraged. If an adequate fee were allowed in
every case of successful re.vaccination, by whatever medical man it was performed, we think there
would probably be a large extension of the practice. We think steps should be taken to impress on
parents the importance of having their children re.vaccinated not later than at the age of twelve years.
We recommend further that when smallpox shows signs of becoming epidemic, special facilities should
be afforded both for vaccination and re.vaccination.
The report is signed by all the members of the Royal Commission except two, i.e., by Lord
Herschell, Sir James Paget. Sir Charles Dalrymple, Sir W. Guyer Hunter, Sir Edwin H. Galsworthy,
Mr. John S. Dugdale, Professor Michael Foster, Mr. Jonathan Hutchinson, Mr. Frederick Meadows
White, Mr. Samuel Whitbread and Mr. John A. Bright (the exceptions being Dr. Collins and
Mr. Picton, who present a separate report).
The following paragraphs are appended.
1. Signed by Sir W. Guyer Hunter and Mr. Jonathan Hutchinson to the following effect—
The undersigned do not find themselves able to go so far in recommending relaxation of the law as
is implied in paragraphs 524, 525, 526 and 527. We think that in all cases in which a parent or guardian
refuses to allow vaccination, the person so refusing should be summoned before a magistrate, as at
present, and that the only change made should be to permit the magistrate to accept a sworn deposition
of conscientious objection, and to abstain from the infliction of a fine.
We are also of opinion that, in spite of the difficulties as set forth in paragraph 533, a second vaccination
at the age of twelve ought to be made compulsory.
2. Signed by Mr. Whitbread, Mr. Bright, Dr. Collins and Mr. Picton to the following effect—
We, the undersigned, desire to express our dissent from the proposal to retain in any form compulsory
vaccination. (Paragraphs 509, 511, 522, 523, 524, 525, 529.)