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We cordially concur in the recommendation that conscientious objection to vaccination should be
respected. The objection that mere negligence or unwillingness on the part of parents to take trouble
might keep many children from being vaccinated would be largely, if not wholly, removed by the
adoption of the Scotch system of offering vaccination at the home of the child and by providing for
medical treatment of any untoward results which may arise.
We therefore think that the modified form of compulsion recommended by our colleagues is
unnecessary, and that in practice it could not be carried out.
The hostility which compulsion has evoked in the past toward the practice of vaccination is fully
acknowledged in the Report. In our opinion the retention of compulsion in any form will in the future
cause irritation and hostility of the same kind.
The right of the parent on grounds of conscience to refuse vaccination for his child being conceded,
and the offer of vaccination under improved conditions being made at the home of the child, it would in
our opinion be best to leave the parent free to accept or reject this offer.
The position of the Royal Commission may be sufficiently understood from the paragraphs in
its report which appear above. It recognizes the necessity of maintaining vaccination as the principle
means of prevention of smallpox. It recommends some relaxation of the compulsory law, not on
account of mistrust of vaccination, but solely with the object of lessening the hostility to vaccination
which results from the enforcement of the present compulsory law. It recognizes that infantile
vaccination is not to be relied upon for protection against attack after nine or ten years, and is of opinion
that children should be re.vaccinated not later than at the age of twelve years, but declines to
recommend compulsory re.vaccination, first on account of the difficulties resulting from movement of
population, secondly on account of the risk of intensifying hostility to the law.
Whatever necessity there has been in the past for the re.vaccination of children approaching
twelve years of age, this necessity will become more urgent if the suggested relaxation of the compulsory
law in favour of the conscientious objector should materially augment the number of children entirely
unprotected against smallpox. Again, whatever objection might be urged against a compulsory
re.vaccination law practically disappears if the conscientious objector is exempted from the requirement
as to the re.vaccination of his child as suggested in the case of primary vaccination.
At the present time the question whether a child shall be re.vaccinated is probably never
seriously considered in many homes in the absence of any requirement as to re.vaccination. There is
no period in the child's life when the parent has to come to definite decision in the matter, and hence
in many cases from sheer apathy, re.vaccination is neglected. The number of parents who had devoted
attention to the subject of re.vaccination is probably small, the greater number have never considered
the matter. A requirement by the State (with exemption for the conscientious objector of the sort
which may be adopted in the case of primary vaccination) that every child approaching the age of 12
shall be re.vaccinated would ensure the re.vaccination of a vast number of children who are now
never re.vaccinated. This requirement would lead to the transference of a large proportion of the
children of such parents from the population which is susceptible to smallpox to the population which
is insusceptible to this disease. The very fact that the State made the requirement would have an
influence which would bs more operative in this respect than any system of recommendation that
sanitary or vaccination authorities could design; and in so far as it was successful it would tend to
secure benefits not only to the children who were re.vaccinated but also to the children of the
conscientious objector, by reducing the opportunities of exposure to infection.
The Royal Commission's reason for the maintenance of a compulsory law for securing primary
vaccination may be equally urged as necessary for the purpose of securing re.vaccination.
(523.) Why, it is asked, should not vaccination cease to be compulsory altogether, and be left to the
free choice of the parents. If no penalty were attached to the failure to vaccinate, it is, we think, certain
that a large number of children would remain unvaccinated from mere neglect on the part of their
parents, or indisposition to incur the trouble involved, and not because they thought it better in the
interest of their children.
On the question of the difficulty of carrying out such administration which the movement of
population presents, 1 would desire to refer to a statement in a recent work published by the authority
of the German Imperial Board of Health.
The lists of children on whom the first vaccination is obligatory are obtained from the register of
births. Under existing circumstances, in Germany the inspection of those who should be presented for
the second vaccination can be best effected in the schools. When, however, children of this age do not
attend any school they can escape re.vaccination, in fact almost insuperable difficulties stand in the
way of controlling such children, but from the health administration point of view such exceptional
cases are without importance.*
Measles.
The deaths from measles in the administrative county of London in 1896 numbered 3,697, as
compared with 2,630 in 1895 and 3,303 in 1894.
The death rates from this disease per 1,000 living in 1896 and preceding periods have been as
follows—
1851.60 0.53
1861.70 0.58
1871.80 0.51
1881.90 0.64
1891 0.431
1892 0.791
1893 0.381
1894 0.761
1895 0.601
1896 0.821
The death rate in each year since 1840, in relation to the mean of the period 1841.96, is shown
in diagram V. The measles death rate of 1896 has been higher than that of any previous year since
1864. In this disease in London years of high mortality alternate with years of low mortality, the
former being probably due to accumulation of susceptible infants. Study of the diagram leads
to the conclusion that during the last ten years measles has been a more fatal disease than during
the preceding ten years, a circumstance that may be due to two conditions, the one being a natural
alteration in the quality of the disease, the other, larger opportunity for its diffusion, such as would
* Blattern and Schutzpockenjmpfung. Denkschrift zur Beurtheilung des Nutzens des Impfgesetzes vom 8th April, 1874, page 78.
† See footnote (l) page 7.