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NA TURE 



255 



Quite independently of such fears — and this also, of course, the 

 Commission pointed out — it is the obvious duty of the State to 

 take every practicable precaution to prevent harm to the indi- 

 vidual through the operation of any Act of Parliament. This 

 applies alike to vaccination and to hospital isolation. If, for the 

 public good, a child is removed from the parental roof to a public 

 hospital* ihe authority so removing it, and coming temporarily 

 in loco parentis, is bound to exercise the utmost care in the pro- 

 tection of the child. Though vaccination differs from hospital 

 isolation in respect that it is done directly for the benefit of the 

 child and only indirectly for the good of the public, yet the 

 obligation remains. Every li-k, no matter how slight, should 

 be minimised by every practicable and reasonably available 

 means hefore the State compels the parent to procure the 

 vaccination of his child. The demand, therefore, that Govern- 

 ment shall itself supply for every rtquired vaccination calf 

 lymph treated according to the best known methods — methods 

 which have been much improved since the Commission issued 

 its Report — or shall efficiently supervise the manufacture of 

 lymph by private makers, is a most reasonable one, and has the 

 support alike of lay and medical opinion. 



It is necessary to consider how this can be done. Here, as 

 in every other mundane affair, questions of finance and economy 

 arise. Before the Act of 189S came into force, public vaccin- 

 ators appointed by hoards of guardians performed about half 

 of the primary vaccinal ions done in London and about two- 

 thirds of those done in the provinces. How the figures now 

 stand I do not know, but at present all that Government under- 

 takes with regard to lymph supply is to meet the requirements 

 of public vaccinators. Private practitioners must find their own 

 lymph. This, at first sight, seems a harsh and arbitrary rule, 

 but it may be assumed that the Local Government Board has 

 some ground for its attitude. The facts of the case furnish the 

 explanation. For due removal of extraneous organisms, calf 

 lymph has to be stored for one month in the glycerine with which 

 it is mixed. If lymph be used too soon, insufficient removal of 

 such organisms may result occasionally in an unnecessary degree 

 of inflammation accompanying the formation of the vaccine 

 vesicles. If stored too long, on the other hand, the lymph may 

 become inert for purposes of vaccination. At present there is 

 great irregularity of demand for vaccine lymph in England, de- 

 pending on the absence of systematic revaccination and the occur- 

 rence of epidemics of small pox. If under present conditions 

 the Local Government Board must always be ready to provide 

 sufficient lymph to every medical man who asks for it for 

 vaccination and revaccination during small-pox epidemics, a 

 great establishment will have to be set up, producing month by 

 month such amounts of lymph as may not be wanted at any 

 time for ten or twenty years on end, and month by month this 1 

 huge excess of valuable material will have to be thrown away. 

 Merely to set forth such a scheme is to condemn it. How, then, 

 is the object to be accomplished ? The answer is, only in one 

 way, and that way a Revaccination Act. Under such an Act, 

 revaccination would be obligatory at about the age of twelve 

 years. The information necessary for working the Act would be 

 most readily obtained from the registers of the elementary 

 schools. The vaccination officials would be furnished at fre- 

 quent intervals, say every three months, with lists of children 

 about to attain the specified age. Primary vaccination would, of 

 course, remain obligatory as at present. Both revaccination and 

 primary vaccination, it may be assumed, would be subject to a 

 Conscience Clause, though the present Clause is open to con- 

 siderable amendment. The work of vaccination would go 

 steadily on. The Government laboratories would be on a scale 

 suited to meet the requirements of the nation, and the public 

 funds would not be sqmndered in maintaining an institution the 

 full work of which would be utilised only at rare intervals. Out- 

 breaks.of small-pox would be few and local and limited in degree, 

 and the laboratories would easily meet demands for lymph for 

 revaccination of "contacts" and others on such occasions. 



Another great advantage from systematic revaccination 

 would be an enormous saving in the provision and maintenance 

 of small-pox hospitals. At present, local authorities are, with 

 regard to this matter, in a most exasperating position, and that 

 through no fault of their own. The Local Government Board 

 insists that, owing to an evil which has often resulted from 

 such hospitals— the spreading of small-pox throughout the 

 surrounding community — these institutions for the isolation 

 of patients shall themselves be isolated. Small-pox is a 

 disease for which hospitals are almost en'irely unnecessary in 



NO. 



1733 



, VOL. 67] 



a duly vaccinated and revaccinated community, yet local 

 authorities have no power to enlorce such protection of their 

 community, and when they set about trying to provide hospitals, 

 they experience the utmost difficulty in obtaining safe sites. 

 Other economies would result from the scheme here briefly 

 sketched, but the above are the main reasons for asking Govern- 

 ment to introduce a Revaccination Bill, and are also among 

 \ the main reasons for the formation of the Imperial Vaccination 

 \ League. Already the Jenner Society has done most admirable 

 work in the same field, and both are well worthy of public 

 support, especially at so critical a time in the history of 

 legislation lor the prevention of small-pox. 



In criticism oi the plea for a Revaccination Act as here put 

 forvvard, it may perhaps be urged that the acceptance without 

 demur of a Conscience Clause with regard even to primary 

 vaccination is hardly consistent with a demand for a law of 

 revaccination. What would be the sense, it may be asked, 

 of establishing all the additional machinery which a Revaccin- 

 ation Act would involve lor the protection of the public against 

 small pox and at the same time telling the public that ii they 

 please they can evade both primary vaccination and revaccin- 

 ation by satisfying a bench of magistrates that they have a 

 "conscientious" objection on the subject? The force of such 

 a contention is not to be denied. Admittedly, the Conscience 

 Clause is a concession to expediency. For justification of such 

 a concession, we must go to the facts of the position. In the 

 first place, it is important to note that the Royal Commission 

 on Vaccination suggested a Conscience Clause with the object, 

 not of lessening thepractice of vaccination, but of increasing it. 

 In the second place, even before the Conscience Clause was 

 passed, vaccination was not in any real sense of the word com- 

 pulsory. In order to evade the operation, it was only necessary 

 to pay a fine, either once or repeatedly, according to the activity 

 or otherwise of the local guardians. The law never allowed a 

 local authority to take a child by force out of a parent's arms 

 and vaccinate it. Exemption, therefore, though not by way of 

 certificate, was always possible. Laws must be framed and 

 administered with due regard to the spirit of legislation which 

 prevails in the country. It it so pleases, Parliament has a light 

 to adopt the altitude that, bad as are small-pox epidemics, they 

 are a lesser evil than would be the exercise of absolute force in 

 such a matter as the insertion of vaccine lymph into the arm of 

 a child notwithstanding the determined opposition of the father. 

 The fining of persistent and active anti-vaccinationists, the 

 public sale of their goods in default of payment of such fines, 

 or the imprisonment of objectors where payment of fines could 

 not in this way be obtained, have been in the past measures 

 most favourable to agitation against vaccination. The purpose 

 of the Conscience Clause in the Act of 1898 was to sift the 

 genuine and confirmed opponent of vaccination from the merely 

 careless and indifferent parent who had no opinion on the sub- 

 ject, but would leave the matter alone so long as he himself were 

 left alone, and would, on the other hand, have his child vaccin- 

 ated if he found that that would cause him less trouble than 

 to take the steps required to obtain exemption from the law. 

 On the whole, the Conscience Clause of 1S98 has probably pro- 

 muted vaccination rather than hindered it. Vet in practice the 

 clause has proved itself defective in two directions. Its ad- 

 ministration has been left to benches of local magistrates, and 

 their views vary much as to the proceedings which should be 

 taken. In one place, an anti-vaccination bench may hold even- 

 ing sederunts where long strings of alleged " conscientious 

 objectors " pass rapidly in front of the bench and are detained 

 only so long as is needed for adhibiting magisterial signatures 

 to exemption certificates. At such gatherings, either fathers or 

 mothers may attend. On the other hand, other benches of 

 magistrates may refuse almost any evidence submitted to them 

 on the ground that it does not "satisfy" them that conscien- 

 tious objection exists, and in Parliament it has been stated, in 

 answer to questions on the subject, that there is no power under 

 the Clause to compel a magistrate to be "satisfied" with any 

 amount of proof. A parent whose certificate is refused in such 

 a court may afterwards be brought before it for having failed 

 both to have his child vaccinated and to produce an exemption 

 certificate. Obviously, the present Conscience Clause allows 

 too much variety of practice and requires a substitute less ojpen 

 to these objections, a substitute which, if possible, should so 

 detail the proceedings to be taken that, on the one hand, they 

 would involve at least as much parental trouble as theprocurjng 

 of vaccination would cause, and, on the other hand, would not 





