THE VACCINATION COMMISSION. F ROM an official point of view it
must be clear that somebody, in Mr. Weller's classic phrase, "ought to be whopped" for the series of indiscretions by which the mbstance of the Report of the Vaccination Commission as become common property many days before that long- expected document, as we can avouch, could be bought— u the usual manner. None the less, the reading public must cherish private gratitude for the enterprise which, at the very outset of the dull season, enabled, first, the York- glare Post—after a few decorous anticipatory hints in the Times—to appear yesterday week with over four columns A a carefully-prepared digest of, and extracts from, he Report, which was only laid on the table of the House A Commons on the previous evening, and then enabled the Standard to follow suit with a summary of its own, together with copious extracts, partly identical and partly supple- mentary. Lord Herschell and his colleagues have un- questionably proceeded in this matter with great delibera- tion. They were appointed in 1889, and one cannot but feel that if they had reported, let us say, in 1894, they would have been open to no charge of scamping their work ; their conclusions would have been the same as they now are; and it is at least conceivable that public opinion in Gloucester, for example, might have been so much affected by their treatment of the subject that the latest object- lesson, and one of the most terrible on record, in regard t..) the neglect of vaccination, would have found no place in medical history. But whether or not the defence with which the Report opens for the long delay in its appear- ance can be regarded as satisfactory. there can be no doubt that it is a most interesting and instructive treatise, and that it is calculated, as its signatories hope, to achieve a valuable educational effect. Of course, to a large extent, this must be a case of the "influence of authority in matters of opinion." The general opinion in favour of vaccination, that is to say, is likely to be confirmed, and, as we should hope, extended in its area, not so much by the arguments in that sense employed in the Report as by the fact that those arguments appear conclusive to so able and representative a body of men as Lord Herschell, Sir James Paget, Sir Charles Dalrymple, Sir Guyer Hunter, Sir Edwin Galsworthy, Mr. Dugdale, Q.C., Professor Michael Foster, Mr. Jonathan Hutchinson, Mr. Samuel Whitbread, Judge Meadows White, and Mr. J. A. Bright, and that only Mr. J. A. Picton and Dr. Collins are more or less otherwise minded. To the motives, and even, in its sphere, to the ability, of Mr. Picton and Dr. Collins every respect may be conceded. But it cannot be doubted that nine hundred and ninety, if not more, out of every thousand ordinary citizens, in regard to any of the ordinary affairs of life, would regard the unanimous judgment of the first-named eleven Com- missioners as decisive, and as practically unreduced in weight by the dissent of the last two. And if, with regard to any of the ordinary affairs of life, why not with regard to vaccination ? These gentlemen have spent seven years in inquiring into the subject from its very beginnings. They have given "full scope "—full, indeed, but quite rightly so—to the evidence of those who are opposed to vaccination as well as to those who favour the practice. They have given thorough and systematic in- vestigation to certain local epidemics, including that at Gloucester, and their examination of cases of alleged injury from vaccination has had a corresponding range. The need for extending that examination over a considerable period is, perhaps, the best of the reasons suggested for the remarkable protraction of the whole inquiry. Unless, therefore, they being the men they are, their unanimous conclusions as to the protective value of vaccination can be broadly accepted, we may as well give up appointing Royal Commissions on difficult public questions, and give up taking the opinion of our most capable friends in the perplexities of private life. And the unanimous con- clusions in question amount to a decisive vindication of the virtue of vaccination,—if only there is enough of it.
The Commissioners, with the two exceptions already noted, are agreed, as the result of an elaborate historical inquiry, that the great reduction in the mortality from small-pox in the first quarter of the nineteenth century was due to the protective influence of vaccination, and not in any appreciable degree to other causes which have been suggested. They are agreed that the marked, though irregular, decline in small-pox mortality observable since 1838—the year after the present system of registration of deaths in England began—is chiefly, if not entirely, due to the same cause. In this connection they forcibly point out that, if the reduction in the death-rate front small-pox were attributable, as some would contend, to the improve- ment in sanitary conditions, a like reduction might have been expected to have occurred in the mortality front measles, scarlet- fever, and whooping - cough, whereas, alas ! nothing of the kind has occurred. On the other hand, the evidence afforded by the experience of vaccinated and unvaccinated persons respectively during recent epidemics of small-pox in several English towns is regarded by the eleven Commissioners as affording strong positive support to their view that vaccination exerts a powerful influence in reducing the mortality from that malady. On this branch of the subject the Report appears to be specially full of interest and value. We must not, however, enter into detail with regard to the eleven Commissioners' arguments. They are agreed that vaccination diminishes the liability to be attacked by small-pox, modifies the character of the disease, and renders it less fatal and of a milder type. They are agreed, again, that valuable as might be the results of a complete system of notification coupled with entire hospital isolation of persons attacked, and super. vision, or if possible isolation, for sixteen days of all persons exposed to the infection, it would be altogether unsafe to rely upon such measures as these—obviously difficult as some of them would be to enforce—as substi- tutes for the protection against small-pox afforded by vaccination. Once more, they are agreed that there is nothing substantial to be alleged, if only proper pre- 411 cautions are taken, on the opposite side of the account. Some of the dangers said to attend vaccination are indeed, in their opinion, undoubtedly real and not in- considerable in gross amount, and yet when considered in relation to the extent of the vaccination work done they are insignificant ; they are diminishing under the better precautions of the present day, and they will diminish further by the aid of the additional precau- tions which experience suggests. The worst dangers apprehended by anybody could be absolutely guarded against by the universal use of calf-lymph, and the Commissioners consider that parents should not be re- quired to submit their children to vaccination by any other material unless they so desire. It might naturally have been supposed that that would be the limit of the modifications proposed by the Commissioners in the present system of compulsory vaccination. Such, how- ever, is not the case. They hold that while it is clearly the duty of the State to promote the vaccination of the people, that end will best be promoted by not overriding the genuinely conscientious objections of any parent. In other words, putting aside the question of the abstract right of the State to compel honestly hostile parents to have their children vaccinated, they believe that the public irritation caused by the punishment of such parents is responsible for a reduction in the number of children vaccinated greater than can be made good by the deterrent influence of the fines imposed. They suggest, therefore, that if a parent attends before the local authority and satisfies them that he entertains a conscientious objection to vaccination, or makes a statutory declaration to that effect before some properly authorised person or persons, no proceedings should be taken against him. We are not surprised to see it stated that some of the medical members of the Commission are somewhat anxious as to the inferences which may be drawn from this sugges- tion, and that Sir Guyer Hunter and Mr. Jonathan Hutchinson desire it to be known that they would not go further than to enact that a Magistrate, before whom any parent refusing vaccination is summoned, may abstain from inflicting a fine if satisfied on the evidence given on oath that the objection was one of conscience. Even so, as it seems to us, we are on dangerous ground. It is easy, as the experience of College authorities with regard to compulsory chapels may suggest, for conscientious objections to be found to any observance that in- volves trouble ; and undoubtedly the vaccination of a child involves, or ought to involve, considerable trouble to the parents. It must be acknowledged, however, that the opinion of the Commissioners as to the ex- pediency of some "conscience clause" is the result of great consideration, and deserves corresponding respect, and also that they only propose that, in the first in- stance, the change should be tried experimentally for five years. Mr. Whitbread and Mr. J. A. Bright go farther' and would abolish all compulsion. They believe that the danger in that case of the children of merely negligent or unwilling parents going unvaccinated would be largely, if not wholly, removed by the adoption of the recommendation, in which they concur with their nine col- leagues, that vaccination at home by a public vaccinator, together with subsequent inspection there—and, as we gather' medical treatment in the case of ill effects— should be offered in the case of all children whose parents do not send in a certificate of successful vaccina- tion within the specified period. This plan, which is very similar to that prevailing in Scotland, certainly ought to secure that fewer children escape vaccination, and that the risks connected with the operation are reduced, but we are by no means inclined to follow Mr. Whitbread and Mr. Bright in regarding it as a satisfactory substitute for all forms of compulsion. We have no space left to do more than allude to the remarkably strong terms in which the eleven Commis- sioners dwell on the need for revaccination. Sir Guyer Hunter and Mr. Hutchinson would make a second vaccina- tion at twelve years of age compulsory. Their nine col- leagues, though abstaining from that recommendation, evidently consider its object one of great importance, and all eleven are said to suggest, on the evidence, that persons specially exposed to contagion should certainly be revaccinated, and that even in the case of those who have been twice vaccinated with success, if a long interval since the last operation has elapsed, it should be repeated a third and even a fourth time! In this connection we are told that after the lapse of nine or ten years "the efficacy of vaccination to protect against attack rapidly diminishes, but that it is still considerable in the next quinquennium, and possibly never altogether ceases; that its power to modify the character of the disease is greatest in the period when its power to protect from attack is greatest, but that its power to modify the disease does not diminish as rapidly as its protective influence against attacks, and its efficacy during the later periods of life to modify the disease is still very considerable." Vaccinations, or revaccinations, which have not "taken," afford no protection whatever. Such are some of the aids furnished to the bulk of the entire adult population of the country in reviewing their position. Perhaps we may add that they would be still further assisted by information on the question whether, in this respect, the personal practice of the eleven Commissioners is in conformity with what appears to be their doctrine.
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