length of this period of highest protection. Though not in all cases the same, if a period is to be fixed, it might, we think, fairly be said to cover in general a period of nine or ten years. 4. That after the lapse of the period of highest protective potency, 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.

4. That its power to modify the character of the disease is also greatest in the period in which its power to protect from attack is greatest, but that its power thus 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.

6. That re-vaccination restores the protection which lapse of time has diminished, but the evidence shows that this protection again diminishes, and that, to ensure the highest degree of protection which vaccination can give, the operation should be at intervals repeated.

7. That the beneficial effects of vaccination are most experienced by those in whose case it has been most thorough. We think it may fairly be concluded that where the vaccine matter is inserted in three or four places, it is more effectual than when introduced into one or two places only-and that if the vaccination marks are of an area of half a square inch, they indicate a better state of protection than if their area be at all considerably below this.

(B) The objections made to vaccination on the ground of injurious effects alleged to result therefrom; and the nature and extent of any injurious effects which do, in fact, so result.

434. A careful examination of the facts which have been brought under our notice has enabled us to arrive at the conclusion that, although some of the dangers said to attend vaccination are undoubtedly real and not inconsiderable in gross amount, yet when considered in relation to the extent of vaccination work done they are insignificant. There is reason further to believe that they are diminishing under the better precautions of the present day, and with the addition of the further precautions which experience suggests will do so still more in the future.

(C)-Whether any, and, if so, what means should be adopted for preventing or lessening the ill effects, if any, resulting from vaccination; and, whether, and, if so, by what means, vaccination with animal vaccine should be further facilitated as a part of public vaccination.

437. We put the use of calf-lymph in the forefront because, as we have said, this would afford an absolute security against the communication of syphilis. Though we believe the risk of such communication to be extremely small where humanized lymph is employed,

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we cannot but recognise the fact that however slight the risk, the idea of encountering even such a risk is naturally regarded by a parent with abhorrence. We think, therefore, that parents should not be required to submit their children to vaccination by means of any but calf-lymph, but this should not preclude the use of humanized lymph in case they so desire.

So long as the State, with a view to the public interest, compels the vaccination of children, so long even as it employs public money in promoting and encouraging the practice, we think it is under an obligation to provide that the means of obtaining calf-lymph for the purpose of vaccination should be within the reach of all. We have no hesitation, therefore, in recommending that steps should be taken to secure this result. Whether the duty of providing calf-lymph should be undertaken by the Local Government Boards in the several parts of the United Kingdom, or whether some other method would be more advantageous, can be better determined by those who have had practical acquaintance with the working of the vaccination laws.

446. 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.

If provision could be made in cases in which insanitary conditions would cause risk to a child, if it remained at home whilst the vaccination wound was unhealed, for its removal elsewhere during that period, we think it would be desirable.

447. We think that the vaccination vesicles should not be opened unless for some adequate reason. We have already said that in our opinion the importance of this has been exaggerated, but the precaution is nevertheless a wise one, and may be of use.

448. We think that safety would be increased by preserving the lymph in tubes instead of on "dry points." There is some difference of opinion on this matter amongst those with whose opinions we have been furnished. On the whole, however, we think the weight of experience as well as reason is in the direction we have indicated.

449. Another precaution which ought to be insisted on is that no instrument should be used for the operation which has not been boiled or otherwise sterilised for the purpose; and the simpler the instrument employed the better.

Care should be exercised, too, not to place the insertions too near together, so as to injure the vitality of the tissues between them.

(D)—What means, other than vaccination, can be used for diminishing the prevalence of small-pox; and how far such means could be relied on in place of vaccination.

499. We have no difficulty in answering the question, what means other than vaccination can be used for diminishing the prevalence of small-pox?-We think that a complete system of notification of the

disease, accompanied by an immediate hospital isolation of the persons attacked, together with a careful supervision, or, if possible, isolation for sixteen days of those who had been in immediate contact with them, could not but be of very high value in diminishing the prevalence of small-pox. It would be necessary, however, to bear constantly in mind as two conditions of success, first, that no considerable number of small-pox patients should ever be kept together in a hospital situate in a populous neighbourhood, and secondly, that the ambulance arrangement should be organised with scrupulous care. If these conditions were not fulfilled, the effect might be to neutralise or even do more than counteract the benefits otherwise flowing from a scheme of isolation.

503. We can see nothing then to warrant the conclusion that in this country vaccination might safely be abandoned, and replaced by a system of isolation. If such a change were made in our method of dealing with small-pox, and that which has been substituted for vaccination proved ineffectual to prevent the spread of the disease (it is not suggested that it could diminish its severity in those attacked), it is impossible to contemplate the consequences without dismay.

To avoid misunderstanding, it may be well to repeat that we are very far from underrating the value of a system of isolation. We have already dwelt upon its importance. But what it can accomplish as an auxiliary to vaccination is one thing, whether it can be relied on in its stead is quite another thing.

(E)-Whether any alterations should be made in the arrangements and proceedings for securing the performance of vaccination, and, in particular, in the provisions of the Vaccination Acts with respect to prosecutions for non-compliance with the Law.

524. After careful consideration and much study of the subject, we have arrived at the conclusion that it would conduce to increased vaccination if a scheme could be devised which would preclude the attempt (so often a vain one) to compel those who are honestly opposed to the practice to submit their children to vaccination, and, at the same time, leave the law to operate, as at present, to prevent children remaining unvaccinated owing to the neglect or indifference of the parent. When we speak of an honest opposition to the practice, we intend to confine our remarks to cases in which the objection is to the operation itself, and to exclude cases in which the objection arises merely from an indisposition to incur the trouble involved. We do not think such a scheme impossible.

Notes are added to the report showing that some of the members differ in their opinion with regard to compulsion, and two of the members make a separate statement of the grounds of their dissent from the report. E. W. W.

KENNY & CO., Printers, 25, Camden Road, London, N.W.

JOURNAL

OF

THE SANITARY INSTITUTE.

CONGRESS AT NEWCASTLE-UPON-TYNE.

SECTION I.

SANITARY SCIENCE & PREVENTIVE MEDICINE.

PAPERS AND DISCUSSIONS.

Small-por and Vaccination," by HENRY W. NEWTON, J.P., Chairman of the Sanitary Committee, Newcastle-upon-Tyne.

INTRODUCTION.

A PAPER on small-pox and vaccination must necessarily embrace statistics which have frequently been reviewed and circumstances which are matters of history. The former may be considered somewhat tedious, the latter unsavoury. But the recent experience of London and Gloucester affords sufficient grounds for reviving the subject, and contrasting the present attitude of the nation towards vaccination with that of 100 years ago. Moreover the question is one of such importance to the public health as to require no apology on my part for introducing it to the consideration of this meeting.

On May 14th, 1796, Dr. Jenner, then in his forty-eighth year, first performed the operation successfully, and raised the standard of triumphant science on the annihilated memories of one of the most deadly and loathsome diseases which humanity has known.

The beneficent effects of vaccination should require no advocacy. The extermination of small-pox in all cases where this preventive has been fairly applied is the universal testimony to its inestimable worth. The immunity from this disease which is now enjoyed has blinded the public to its horrors, and generated a disregard for the protecting influence which it affords.

In order to appreciate the value of vaccination and to afford some idea of the terrible conditions which Jenner laboured to ameliorate, we must glance at the prevalence of small-pox before his time.

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The first reliable description of it was given by a Christian priest who associated the healing art with his sacred calling at Alexandria in the reign of the Emperor Heraclius, A.D. 610641. From time to time during the Middle Ages this disease devastated Europe. It was considered contagious and looked upon as an unavoidable evil to which the human family must at least once, sometimes twice or even thrice submit. The fearful and fatal character of epidemic small-pox cannot be appreciated by those who have not witnessed it, but thanks to the efficacy of vaccination in our day, it is almost unknown except in the literature of disease.

It was our duty to encounter one such outbreak some twentyfive years ago, and then, as recently in Gloucester, its victims were found amongst those who, through ignorance or prejudice, refused to avail themselves of the great discovery of Jenner.

In the ninth century we find a learned man explaining why hardly any were exempt from small-pox, and why children, especially males, rarely escaped its attacks.

In 1593 Hellwaye, the author of the first systematic treatise on small-pox, says: "I need not greatly to stand on the description of this disease, for it is a thing well known unto most people.'

In 1688 a person was advertised for in the London Gazette; he was the utterer of false coin and was thus described: "John Bayley, a short and burley man, fair and fresh coloured, without poch-holes, flat-nosed and under forty years of age, commonly weareth a fair periwig, and useth a blue as well as a red coat;" whence we see that the absence of "poch-holes" was the exception, their presence the rule.

Lord Macaulay, writing of the death of Queen Mary from small-pox in 1694, tells us of the public appreciation in which it was held at the end of the seventeenth century. He says: "That disease over which science has since achieved a succession of glorious and beneficial victories was then the most terrible of the ministers of death. The havoc of the plague had been far more rapid, but plague had visited our shores only once or twice within living memory, and the small-pox was always present, filling our churchyards with corpses, tormenting with constant fears all whom it had not yet stricken, leaving on those whose lives it spared the hideous traces of its power, turning the babe into a changeling at which the mother shuddered, and making the eyes and cheeks of the betrothed maiden objects of horror to the lover."

Horace Walpole in a letter to a friend, dated April 21st, 1758, says: "Lord Dalkeith is dead of the small-pox in three days. It is so dreadfully fatal in his family that besides several uncles and aunts, his eldest boy died of it last year, and his only