REPORT OF THE ROYAL VACCINATION COMMISSION. 687 



absolutely to exclude risk. The evidence given by Dr. Husband, of the 

 Vaccine Institution of Edinburgh, established the fact that all lymph, 

 however pellucid, does really contain blood cells. Absolute freedom from 

 risk of syphilis can be had only when calf-lymph is used ; though where 

 the antecedents of the vaccinifer are fully ascertained, and due care is 

 used, the risk may for practical purposes be regarded as absent. 



It is obvious that the employment of calf -lymph only would wholly 

 exclude the risks as regards both syphilis and leprosy. Respecting the 

 latter disease, however, there appears to be reason to doubt whether any 

 risk exists, and at any rate it .does not concern the British population. 

 Even in leprosy districts the employment of English human lymph would 

 be, so far as leprosy is concerned, as safe as that from the calf. 



There can be no doubt that vaccination ought to be postponed when 

 erysipelas, scarlet fever, measles, or chicken-pox are prevalent in the 

 neighbourhood of the child's residence, or, if the child is not to be 

 vaccinated at home, either there or near the place of vaccination. Here 

 again there would be a gain if the home was more often the place of 

 vaccination. 



It would, in our opinion, be an advantage if the postponement of 

 vaccination were expressly permitted, not only on account of the state of 

 the child, but of 'its surroundings and any other conditions rendering the 

 operation at the time undesirable. If more discretion in this respect 

 were possessed and exercised, we think untoward results would become 

 even rarer than they are. 



We are quite alive to the objections which may be urged against a 

 prolongation of the period within which vaccination must be performed. 

 It will naturally be said that a number of children, who otherwise would 

 be protected against small-pox, would be left without that protection, 

 and would thus be liable to suffer from the disease themselves, and be a 

 source of danger to others. It must be remembered, however, that so 

 long as children cannot walk, the risk of their contracting contagion is 

 less than if they were able to move freery about and mix with other 

 people, and that, for the same reason, the risk of their communicating 

 contagion to others is less. We cannot trace in the statistics relating to 

 Scotland any grounds for believing that the later compulsory vaccination 

 age which prevails in that country as compared with England has affected, 

 to any substantial extent, the general small-pox mortality of Scotland, 

 though no doubt it may have led to some deaths among children under 

 six months of age which otherwise would not have taken place. 



We have already shown how satisfactory a position Germany has 

 occupied in relation to small-pox since the year 1874. The age of com- 

 pulsion in that country is the end of the next calendar year after birth. 

 It is true that re- vaccination has been there made compulsory as well as 

 primary vaccination ; but we think the experience of Germany is not 

 without its bearing on the question we are now considering. Wherever 

 the line is drawn, whether at three months or six months, it will always 

 leave a class of unvaccinated persons. The age to be fixed is a question 

 of policy into which many considerations must enter. If an extension 

 of the age within which vaccination was required rendered its untoward 



