MR. WILLIAM LOGAN (Langley Park) said he had been a Poor Law Guardian for twenty years, and his experience was this-that instead of the Commission sitting to relax the laws of vaccination it ought to have sat to strengthen them, and to take away the power from any Board of Guardians to say whether they should be carried out or not. When they elected a popular body and gave them a permissive power, they would find that there were a number of people who would go contrary to common sense, simply because they got the permission. In his own union, which comprised a population of nearly seventy thousand people, they had always carried out the law strictly and impartially. In the last twenty years they had only had one very slight epidemic of small-pox, and that did not originate in the district; it was imported. As to making the Registrar of Births and Deaths the official to carry out these prosecutions he did not think, if the Board of Guardians were not an efficient body, that that official would be an efficient person, because he was appointed by the Board of Guardians.

Dr. PARK (Houghton-le-Spring) said that as a public vaccinator he was compelled to put on four marks, and. those marks must be of a certain size, whilst others in the town and immediate neighbourhood could satisfy the requirements of the Act by putting only one mark on. He thought that had a very serious effect, and the Local Government Board should see that it was altered.

Mr. JOHN S. BRODIE (Whitehaven) thought in their various capacities as Poor Law Guardians, Members of Councils, and so on, they might personally educate their constituents in regard to vaccination. Some people had certainly an idea that this vaccination was a very terrible thing. He had himself been vaccinated and re-vaccinated twice, not because he had been afraid of small- pox, but on principle. He thought there should be less fear and prejudice against the principle of vaccination.

Miss WILLIAMS, M.D. (Newcastle-upon-Tyne), said she had been reminded of two classes of circumstances under which she had been called upon to grapple with the beginnings of small-pox epidemics. Neither of these classes had been touched upon during the discussion, and she thought perhaps it might be a matter of interest to mention them. The first class of case originated in a country workhouse among the casuals. When she was first qualified it was her fate to see that case drag itself through three or four country workhouses. The second class, which she had come across lately, were the dangers which arose from the large shelters which one found so common in East and South London. She had been working lately in the neighbourhood of one of those shelters which had produced two small epidemics, and on one occasion kept them busy with quite a serious epidemic. She would like to say one word on another point which had occurred to her, and that was as to a case of so called insusceptibility to vaccination. She had had a great many cases of adults brought her, mostly people who wanted to enter

1

some situation in which they were required to be vaccinated, who had avowed and declared that they had been vaccinated and re-vaccinated by most competent authorities. Yet she had never found a single case which was insusceptible, and she did not believe such cases could

exist.

Mr. P. B. STONEY (Millom) was in hope that in a meeting like that, remarks would be made which would help future legislation in regard to public vaccination. His own feeling on the subject was-and he had been a public vaccinator for two or three and twenty years-that a great feeling against vaccination was often engendered by practitioners who felt that their work was taken away from them by the public vaccinator. He saw a report a little while ago from a Medical Officer of Health which suggested that all medical men should be public vaccinators and that Medical Officers of Health should inspect the cases. That would do away with the feeling which was engendered in many medical men's minds. He himself believed that some medical men in a district only vaccinated in one or two places. He held the strong opinion that if all medical men were appointed public vaccinators and paid by the State, that feeling would be done away with. Vaccination would be compelled to be efficient, and he did think that on those lines they would do away with a great deal of the feeling which was engendered by public vaccination as it now existed.

Mr. HILTON (Barnard Castle) said that as a Guardian he had taken rather an active interest in what might almost be called antivaccination. Not altogether so; but he had a strong opinion that compulsory vaccination was not the thing they ought to have provided when the community at large might suffer by it. His reason was partly grounded on this: A young girl, graduating as a school teacher, was sent to Durham. Her parents were poor people, and he had induced them to go into a building society, and they had got £20 scraped together. This poor girl after being vaccinated, became a total wreck, and the £20 went. The authorities had been very good, and they had put her into as good a situation as they could. Andher Guardian had told him of a case where at least one child died before the effects of the operation were fairly gone, and he attributed the death of the child to the operation. Would they send those parents to gaol if they would not have any more vaccinated? He would like, if possible, to elicit something which would partly guide one's conduct hereafter.

Sir CHARLES CAMERON (Dublin) said he would like to say a few words with regard to what vaccination had done for the country that he came from. The country he came from was one which was noted for being a law abiding one. He was sorry to say that in many parts of England they did not respect the laws. communities, having a perfect organization, had set the laws of this great Empire at defiance and snapped their fingers at them. The laws in relation to vaccination had been defied in England,

Whole

No one had

There had been vaccination was There was no

whilst they had been strictly observed in Ireland. ever objected to the Vaccination Laws in Ireland. implicit obedience paid to them. In Ireland also very early carried out, and with excellent results. question in the world that if England had suffered severely from small-pox in the last century and the beginning of the present one, Ireland suffered still more. In the towns of Ireland there was much poverty and much overcrowding, and all the factors that were essential to wide-spread diseases of that kind were present, and therefore in Ireland small-pox was an extremely common disease. Indeed, he remembered in his own early days, in the beginning of the century, he often noticed people with marks of small-pox. It was impossible when he was a little boy to walk from one end of the street to the other in Dublin without meeting at least one, and perhaps half-a-dozen persons bearing on their faces the marks of that fell disease. Now, of course, they knew that small-pox was not such a disease as it was once. It did not as a rule produce the terrible marks upon the faces of its victims that it did in those early days. The disease itself appeared to have undergone some kind of modification. He thought that it was largely due to the fact that there was perhaps not a single person in the United Kingdom some of whose ancestors had not been vaccinated. Although he was a believer in re-vaccination he believed that the people of these countries now, whether vaccinated or not, enjoyed a certain amount of protection from the fact that their ancestors had been vaccinated and re-vaccinated. There was perhaps no other way to account for the fact that the disease was now so much milder as compared with former times when small-pox was so prevalent. When vaccination was first introduced it was very widely spread throughout the whole country. In rural districts in Ireland inoculation was general and they were quite prepared, therefore, for a substitute for inoculation. He had made a special inquiry into the history of vaccination in Ireland some years ago and was quite satisfied that vaccination early in the century became very general in that country, but the effects were not so widely felt as the effects of vaccination were in the present day. In Ireland, under the influence of vaccination-vaccination continued through many generationsthe disease for many years until quite recently, was completely absent. For many years Ireland was in the position of being able to say that she had not a single case of small-pox in the country. Unfortunately, in Dublin, after a very long interval of time, an epidemic, due to the introduction of the disease from England, occurred the year before last. The disease did not assume very large proportions, and it had now completely died out, but during the progress of that disease never was the influence of vaccination more strikingly shown. It was so incontrovertable that no one for a moment thought of questioning the value of vaccination in Dublin. In the epidemic which occurred there he thought there was scarcely a single case amongst persons who had been re-vaccinated. None of the nurses, none of the doctors, none of the medical students-except

The

the case of a medical student who had not been re-vaccinated-were affected during the epidemic. Therefore he thought in Ireland at all events, the influence of vaccination had been very clearly established. He would like to touch upon one other point: the negligence of some persons in regard to vaccination. In Ireland, as previously mentioned, they were a very law-abiding class of people; they did not disobey the law willingly, but they sometimes did it from mere carelessness. All persons in Ireland believe in vaccination, but from carelessness of one kind or another, they did not always get their children vaccinated. That was the case in Dublin. Sanitary Authority in Dublin was not responsible for the carrying out of vaccination, that was a responsibility that devolves on the guardians, and the guardians did not do their duty in enforcing vaccination, or rather in finding out where the children were who had not been vaccinated. One cause of that was that the relieving officers whose duty it was to ascertain where the children were who had not been vaccinated, but whose births had been registered, neglected to do their duty because they got a fixed salary. When people got a fixed salary there was naturally a tendency to do a minimum amount of work for it. He suggested therefore, payment by results. Pay the relieving officers sixpence for every child whom they discovered had not been vaccinated. A great difference was seen at once. There was a search through every corner of Dublin and the result was that thousands were brought up. He was able to collect some statistics, and found that about 40,000 people in Dublin were vaccinated or re-vaccinated, but during the whole period of that epidemic, and during the terrific scramble to get vaccinated there was not a single person known of-not one-who questioned the efficacy of vaccination.

THE MAYOR OF COVENTRY said he thought it might strengthen the hands of the Commissioners when the subject came before the House of Commons for discussion if a resolution was passed from this meeting. He thought that there was a great unanimity of feeling that the time had gone by for the power to be retained in the hands of the Board of Guardians for the carrying out of the Vaccination Act. He thought that was a strong feeling that had permeated the whole country. He spoke from an experience of twenty-five years as a Guardian, and was sure it would never be carried out as it ought to be unless it was taken out of their hands and placed under a different authority. If a resolution was passed to that effect it would be of great benefit.

The PRESIDENT of the Section (Professor Corfield) said a resolution of that kind could not be passed by the Section without due notice had been given, and without its being printed in the Daily Journal of the Congress.

On "The Spread of Enteric Fever by means of Sewage Contaminated Shell-Fish," by ARTHUR NEWSHOLME, M.D., Lond. M.R.C.P.

(FELLOW.)

SOME months ago an intelligent clergyman expressed surprise that with so many doctors there was any disease left. I made the obvious retort that it was even more surprising that with so many clergymen, sinners still abounded. The two cases are of course only comparable in so far as sin and disease are both caused by aberrations from the path of duty over which the individual or the community could exercise control. But the clergyman's remark is interesting, as illustrative of the lack of appreciation by even the educated public of the difficulties connected with the prevention of disease. Even given a known cause, how long before its practical removal is attempted, as witness the present almost complete lack of supervision in this country over the distribution and consumption of milk from tubercular cows. But in too many instances, our knowledge of the causation of diseases is still most imperfect; and then our preventive measures must necessarily be empirical and uncertain.

Take such a disease as enteric fever. It is certain that this is caused by the inhalation or probably oftenest by the swallowing of a specific micro-organism. That this is most commonly conveyed by means of milk or water which has become specifically contaminated is well known. That the effluvia from defective drains sometimes cause it, appears highly probable; though I doubt whether having regard to the consideration that defective drains are extremely common, and cases of enteric fever comparatively rare, it would be possible to satisfy the searcher after truth with a strongly logical mind, that the relationship of cause and effect between bad drains and cases of enteric fever had been clearly established in any given cases.

When an outbreak of enteric fever comprising a considerable number of cases within a short time is being investigated, it is usually comparatively easy to discover the facts common to all. When, however, single cases are being investigated, the task is more difficult, and one has frequently to be contented with a lower degree of probability as to causation. I may perhaps be allowed to instance my own case.

On Dec. 31st, 1895, I came home with headache and general malaise. Next morning I found that my temperature was over 102°, and I then passed through a well-marked attack of enteric fever followed by a relapse. How had this been acquired? I

VOL. XVII. PART IV.

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