470 



NATURE 



[September 15, 1898 



the position of the man who hears only the anti- 

 vaccinator's story, and who is moved to the action he 

 takes in regard to his own children by ignorant sentiment, 

 and not by actual information. Practically compulsory 

 vaccination has failed, because, as soon as the danger 

 against which it was to protect was temporarily lost sight 

 of, it was no longer enforced. Medical men were not 

 oblivious of the danger of the recurrence of small-pox in 

 unvaccinated communities, but they have not been able 

 to convince their patients of the existence of the danger. 

 Under these conditions, what can be done to counteract 

 what has come to be a most dangerous agitation, the 

 danger and importance of which, unless proper steps are 

 taken, will go on increasing with every year that we are 

 removed from the small-pox period, until we are again 

 confronted with an unvaccinated population and a general 

 epidemic of small-pox such as has not been experienced 

 in the time of the oldest amongst us ? 



One step has already been taken : the man with con- 

 scientious objections (and it must be remembered that 

 such men do exist, otherwise there would be no funds forth- 

 coming for the payment of those by whom the agitation 

 is principally kept alive) is allowed to enter his protest, 

 and to prevent the child entrusted to his care from 

 receiving protection against a disease which may disfigure 

 and maim it for life. 



The next step is to take every precaution (and to make 

 punishable every lack of known precaution) that the 

 lymph used shall be of the best, and the operation carried 

 out under the most favourable conditions possible. In 

 these days of surgical cleanliness, medical men do not 

 require to be specially trained in respect to these two 

 points. 



Lord Lister, in his speech before the House of Lords, 

 insisted strongly on the necessity of revaccination, on 

 the ground that in the course of a few years the pro- 

 tective effect of vaccination gradually becomes weakened. 

 This fact certainly came out very prominently before 

 the Royal Commission, and, as may be gathered from 

 the final report of the Commissioners, bulked largely in 

 their minds when they made their recommendations for 

 the guidance of future legislation. In the event of any 

 serious attempt to continue the anti-vaccination move- 

 ment, revaccination must form an important factor in 

 the prevention of the spread of small-pox in epidemic 

 form. When there is any outbreak of small-pox, those 

 who have not already submitted themselves for revacci- 

 nation, especially those who are in any way brought into 

 contact with the disease, hasten to have themselves 

 revaccinated, with, as is pointed out by the Report of the 

 Commission, the very best results, as proved by the 

 statistics relating to doctors, nurses, and others attending 

 directly on small-pox patients. So, also, when there is the 

 possibility of an outbreak of small-pox in epidemic form 

 amongst those whom parents and guardians have left sus- 

 ceptible to the attack of this disease, revaccination should 

 constitute an additional line of defence even for those 

 already vaccinated in infancy. Under such conditions the 

 vaccinated community may regard with equanimity the 

 possibility of infection by small-pox, so far as they them- 

 selves are concerned, though they will still have to bear the 

 brunt of pecuniary calls made for the stamping out of 

 the disease in the unvaccinated or imperfectly vaccinated 

 section of the population. The Vaccination Bill has been 

 spoken of as " a great experiment." We do not hesitate 

 to state that, under the above conditions, it will be one 

 of the most convincing experiments ever performed, 

 especially if a record, to which reference may afterwards 

 be made, be kept of every conscientious objector. With 

 vaccination and revaccination efficiently carried out in 

 the bulk of the population, atid registration of the tm- 

 vaccinated residuu}n,th\s latter will no longer be a source 

 of danger except to itself 



One thing more remains to be done to meet the anti- 

 NO. 1507, VOL. 58] 



vaccinators with their own weapons. This matter, as 

 Dr. Bond has pointed out, has been left too much in the 

 hands of the medical man, who, as a rule, has little time 

 and less money to devote to the carrying on of any 

 propaganda in favour of vaccination. The bulk of the 

 agitation against vaccination is carried on by laymen, 

 many of whom display ingenuity and perseverance worthy 

 of a better cause. These laymen, as for example in the 

 Houses of Parliament, are convinced — often by mere hear- 

 say — that they are thoroughly in the right, and the only 

 way to deal with them successfully is to bring every scrap 

 of evidence under their notice tellingly,and in authoritative 

 form. This, for the present, can only be done by other 

 laymen who have made a careful study of the question. 

 In time bitter experience will convince some, but isolated 

 cases, unless carefully made known, are of little value for 

 the conviction of those not specially concerned. The 

 Jenner Society has a great work before it in educating 

 the public by making known everything that is to be 

 said m favour of vaccination, and by recording the per- 

 sonal experience of those who have been attacked by 

 small-pox. As an example of the effect of an outbreak of 

 small-pox on the opinions of an anti-vaccinator, the follow- 

 ing may be taken as being fairly typical. Mr. H , a 



well-to-do and intelligent " Clerk of Works " on a large 

 developing estate in Kent, was a strong anti-vaccinator. 

 When the time came for him to have his first-born son 

 vaccinated the law was evaded. A few years later, 

 during an outbreak of small-pox, a tramp, suffering from 

 the disease in an early stage, came to H.'s door to beg, 

 and the child, sent to give him a piece of bread and 

 butter, contracted small-pox, and, as the father and mother 

 say, suffered most horribly. It was thought that the 

 sight of both eyes would be lost, and the boy was terribly 

 disfigured. So impressed was the father with the seventy 

 of the attack as compared with those in children who had 

 been vaccinated, that he has had his other children 

 vaccinated, and says that he would now gladly walk 

 twenty miles and give ten shillings to help to persuade 

 any father who has " conscientious objections " to vac- 

 cination to change his views on the subject. There are 

 few such cases nowadays, but such a record is only the 

 echo of what at one time was frequent enough, and unless- 

 the public takes up this matter in earnest, will be in the 

 future. Doctors who understand what vaccination has 

 already done will continue their efforts to protect the 

 community, and will certainly see that this is done in 

 their own families ; but it rests with the wealthy and 

 intelligent layman to do what he can to counteract the 

 influence of anti-vaccination statements, spoken and 

 printed, on the minds of the public. 



Vaccination is a prophylactic measure, not a curative. 

 Its beneficial effects can, therefore, not be seen except 

 through statistics and in the modification of the type 

 of the disease in those attacked. Moreover its effects 

 can, even in these cases, now only be rarely seen, as owing 

 to its action small-pox but seldom makes its appearance. 

 Let it be remembered, however, that when anti-diphtherial 

 serum was first introduced in this country there was a 

 tremendous outcry against its use. "The brute force of 

 facts" has silenced objectors for the present. With a 

 death-rate reduced totwo-thirds, or even one-half of what 

 it was only three or four years ago, and with the type of 

 disease completely altered (only, however, in those cases 

 in which antitoxin is given), even the most obstinate 

 objector is constrained to keep silence ; but there can be 

 little doubt that should diphtheria be almost eliminated 

 from our midst, a prospect by no means beyond the reach 

 of possibility, there would in time rise up a generation 

 of doubters and objectors who would assail the anti- 

 diphtherial serum treatment as stoutly and as blindly as 

 do the anti-vaccination party of to-day and as did the 

 anti-serum party of yesterday. 



It may be said that sensible people do not listen to the 



