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Central Authoritative Rules for Prevention

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CENTRAL AUTHORITATIVE RULES FOR PREVENTION.

When all that can be done by personal effort is done, and when personal effort is backed by local administrative authority, little remains for a central government to perform. And, as a central government is comparatively powerless in a free country, unless it be acting in accordance with the will of the people, it has but little to do with matters in which the people are ready to act for themselves. On the subject of the prevention of zymotic diseases there are, however, a few rules required which can only be carried out by the central authority.

Registration of Disease.

The registration of births and deaths which has been going on since 1s3s has proved the most valuable record extant of the nature, course, and progress of the zymotic diseases. That ought now to be supplemented by a registration of those diseases, so that we may not only see what those diseases pay over to death, but what health pays over to them. I suggested this work of registration to the Government nearly a quarter of a century ago. I also organized a voluntary plan of such registration, and with over fifty stations, extending in different points of the country from St. Mary's, Scilly, to the Shetland Islands, carried on the plan for some years. The details were placed by me before Sir Benjamin Hall when he was President of the Board of Health, and obtained his strong approval. But the project lapsed, and although it has been carried out in some particular localities, under local authority, it remains yet to be brought into a general scheme in the United Kingdom and to be affiliated with the pres ent work of the Registrar-General.

Through the registrars of births and deaths these returns of disease should now be collected. A law is required rendering it necessary for every householder to make a return of the conta gious disease which is present in his house. The return should go regularly to Somerset House, and should be embodied, sys tematically, in a weekly statement.

Collateral returns relating to the meteorology of districts in which the diseases occur, and of epidemic diseases of cattle, domestic animals and plants, should also be collected. From such returns, coupled with complete geological survey of the dis tricts, we should, in a few years, possess a perfect natural history of the spreading diseases. We should know precisely their modes of origin, their course, and their relations one to another, as well as their mortalities, from which facts we should soon learn how to prevent them altogether.

Compulsory Prevention. Vaccination.

The compulsory enforcement of measures for preventing dis ease on what are called prophylactic principles is a subject which has led to the active administration of the Government in regard to one particular disease, Small-pox. The Government enforces vaccination as a prophylactic measure against small-pox. Some years ago that measure was made compulsory by Parliament, with the assent of the greater part of the nation that had paid atten tion to the question involved. Of late years a very powerful opposition to vaccination has been started, and active measures have been taken by many energetic and conscientious men to bring about a repeal of the compulsory act. It is important to place this question in a true and impartial light.

There is no doubt from the evidence at command that the disease Cow-pox, which is induced by vaccination, prevents those who have suffered from it from contracting the more severe disease small-pox. Again, there can be no doubt that cow-pox itself, pure and simple, that is, uncomplicated by any accident, is a harmless disease, while small-pox is one of the most serious. As a matter of exchange, therefore, of one disease for another, presum ing that one or other must be had, cow-pox has everything in its favor.

Again, admitting that cow-pox is attended by certain accidents, by the introduction into the body of erysipelas, syphilis, and some other diseases, if the choice of two evils be an absolute necessity, the balance is all on the side of vaccination.

The next point then which we have to discuss is whether small pox must exist if cow-pox be not compulsorily enforced ? To understand this question we must consider on what ground vaccination stood when it was first introduced.

Vaccination was brought in by Jenner in order to supersede a process called inoculation for small-pox, a process by which small pox was systematically propagated from one person to another by operation. This began in the early part of the last century, and became so general it may have been considered all but universal. A few years before the close of the century a census was taken of Brighton and of some other towns, as preparatory to a general inoculation of the people. In this way every village and every town, we may almost say every house, became a centre of small pox, because wherever the disease was propagated by inoculation it was also propagated by infection. It was at this period, when the country was saturated with the contagious disease, that Jenner came forward with his antidote, and it is not in any way surprising that by his substitution of a comparatively harmless inoculation for a terribly fatal one, he changed the state of things altogether, and created a triumphant success for himself which no one could dispute.

That which remains to be determined is, whether by this suc cess he merely corrected an egregious blunder in assumed prophy lactic practice, or whether he went further, and introduced a plan for preventing the natural disease, irrespective of the mischiefs produced by inoculation.

The truth lies probably between the two extremes. The most determined opponent of vaccination must acknowledge, if he will be fair, that Jenner, in substituting vaccinia for variola, cow pox for small-pox, substituted a protective disease against small pox which in itself was harmless, and which had this indescribable advantage, that the protective disease, unlike small-pox, was not of an infectious or contagious character, except when it was pro moted for a distinct objeet by a specific operation.

The effect of this introduction was, naturally enough, stupen dous. If inoculation had been given up, small-pox would have continued in the most wide-spread manner, because the disease was everywhere, and every dwelling was so infected with it that nothing short of insusceptibility to the affection by the process of contracting it could be considered as protective, while every per son who took the disease became another instrument for its prop agation. In a word, the whole population was obliged to have small-pox, and I remember myself being shown by a relative of mine, who entered the practice of medicine before vaccination was accepted, a large village where every resident in it had, with out a single exception, been through the small-pox. Vaccination swept this away. It afforded a protection; it did not afford an infectious disease. It checked the universal evil; it gave time for the general disinfection of the country from small-pox poison. Its good effect was so immense that all secondary evils incident to it were naturally overlooked.

So much for the original value of vaccination. It has played a most important part, and has, in all probability, by giving time for general removal of small-pox poison from the homes of the people, brought the suppression of small-pox within the range of sanitary measures alone, without necessitating, for many years longer, the enforcement of vaccination.

The opponents of vaccination wish it to be accepted that that time has now come. They direct our attention to Jurin's and Net tleship's remarkable computations about the mortality of small-pox before the introduction of inoculation, and they urge that the mortality from small-pox of persons who take the disease after vaccination is not greater than that of persons who, in the old times, died from the original small-pox, namely, 18 per cent.

What Jurin said was the following : (a) That of all children that are born in England at the time he wrote, 1722, there will at some time die of small-pox one in fourteen.

(b) That of persons of all ages taken ill of the natural small pox, there will die of that distemper one in five or six, or two in eleven, or just over 1s per cent.

(c) That of persons of all ages inoculated for small-pox, with out regard to the healthiness or unhealthiness of the subject, as N was practised in New England, there will die one in sixty.

(d) That of persons inoculated with the same caution in the choice of subjects as has been used in England, there will die of the inoculated one in In these notes we see why inoculation became popular. It seemed to produce amongst the inoculated a great reduction of mortality, and if it had not at the same time produced an infective disease, which raised the general mortality from the infection, it would have been a blessing of no mean kind. As it was, it was a disaster which vaccination signally corrected.

In this day we have got over that disaster so far, that if throughout our towns we had proper hospital accommodation for the reception of all small-pox cases so soon as they occur, and means for the complete destruction of the virus which each case repro duces in such abundance, we could soon stamp out small-pox altogether by ordinary sanitary measures without vaccination. These measures must, however, be perfect, because if vaccination were withdrawn the whole of the new generation would grow up susceptible to small-pox, and, the virus being diffused in such an unprotected population, a universal epidemic could easily be spread over the whole land.

From these observations, which I have penned without the slightest bias on either side, the intelligent reader will, I trust, become enabled to form a correct judgment of what the Govern ment of the country ought to do in respect to legislation on vac cination.

The effects of vaccination are summarized by the Medical Officer of Health for the Privy Council, Dr. Buchanan, F.R.S., in his late Report to the President of the Local Government Board for the year 1ss1.

In 1ss1, among 55,000 children who had not been vacci nated, there were 7s2 deaths from small-pox; among s61,000 children who had been vaccinated, there were s25 deaths from small-pox in London.

If the London children under ten who were unvaccinated had had the protection of vaccination, not 7s2, but 9, would have died of small-pox during the year.

If the s61,000 vaccinated children had died at the rate of the 55,000 unvaccinated, 12,125 deaths would have occurred from small-pox during the year instead of the 125 that did occur among the London population under ten years of age.

If it be urged, as it has been, that the vaccinated children owed their escape from small-pox not to vaccination, but to the circumstance that they belonged to the richer and better lodged section of the community, the hypothesis is negatived by the facts.

The children vaccinated at the public expense number about 430,000. This is more than half the child population, and be longs to the poorer population. If the rate of death among the unvaccinated children had prevailed also amongst this poorer sec tion of the vaccinated, then among these children vaccinated at the public expense there would have been over 6,000 deaths from small-pox in 1ss1. In reality the outside number of deaths was 35, and indeed this poorer half of the vaccinated community had a less mortality than the richer. These facts speak for them selves, and are a clear set-off against 12 deaths registered in Lon don in 1ss1 as from cow-pox and disease occurring after vac cination.

For my own part, with all the facts that are in my possession before me; with a knowledge that without protection the suscep tibility to small-pox is as distinct as ever; with a knowledge that the virus of small-pox is still present in many thousands of cen tres; with a knowledge that amongst an unprotected community small-pox might easily ravage the whole of a nation; with a knowledge that vaccination, notwithstanding all its drawbacks, is a protective without being an infective disease; and, with a knowledge that sanitary measures are not sufficiently advanced to admit of the withdrawal of the protection of vaccination, it is I feel out of reason to request the Government to break up the great organization for vaccination which it has established. I have been vaccinated myself three times, and have had those who have been under my control vaccinated and re-vaccinated, a prac tice which is, I believe, all but universal amongst the members of the profession to which I belong, a profession which ought to be best acquainted with its own interests if with none other.

It rests with politicians rather than with the men of science to determine whether it is good practice to make vaccination com pulsory, and speaking on the political side I do not think it is. At present the compulsory method is doing the greatest injury to vaccination by making it so unpopular that people will not listen to reason on the merits of the process; in time it will bring dis credit on the process altogether, as a useless and tyrannical measure.

In conclusion, it seems to me to be the duty of the Govern ment to retain the existing organization, and to make vaccination as healthy and perfect as possible; but to withdraw all penalties for enforcement, and to stop at once the unseemly trials for enforcement, which raise an emotional disgust or dislike, without in the slightest degree satisfying the reasoning nature of the people.

Other suggested Prophylactic Inoculations.

In imitation of vaccination, it has of late years been proposed to attempt to prevent other of the spreading diseases than small pox by means of counter-inoculation, on the homoeopathic prin ciple of keeping off a severe by bringing forth a similar but milder disease. There are some who would persuade our Govern ment to let this experiment be tried on our flocks and herds, and who would introduce a series of spick and span new diseases, on the chance that certain old diseases, which are perfectly under san itary control, may be conjured out instead of being kept out. This would not be a sound governmental proceeding. Already the hypothesises who are the head and front of this experimental crusade are quarrelling amongst themselves as to the validity of their own experimental data. They have not proved to the sat isfaction of each other that they have discovered the art of pre venting susceptibility by inoculation; and, worse than all, they have not proved that the artificial protective diseases which they think they can induce are not, when once induced, infectious and communicable independently of mere artificial and controllable propagation.

Contagious Diseases Acts.

The Legislature of this country has attempted, through the Contagious Diseases Acts, to suppress, by legal measures, the spread of certain diseases which convey the worst description of contagion and which confer the most destructive heredity. I have studied with the utmost care what has been said on both sides of this important question, and have come to the following conclusions: (a) That the Acts where they have been applied have tended to the reduction of one of the worst forms of human disease.

(b) That, as the advocates of the Acts claim for them, they have conferred advantages other than hygienic. That they have:— "Diminished prostitution in subjected districts.

" Almost entirely suppressed juvenile prostitution.

"Rescued fallen women from the frightful state of filth and disease in which they had previously lived, and placed them under conditions in which they, for the first time, become amenable to humanizing and reforming influences.

" Contributed to promote public order and decency in the dis tricts in which they are in force." Water Supply and Drainage.

In the prevention of diseases of the zymotic class it is perhaps essential, that the Government of the country should take into its own hands the management of the water supply, and should carry out for the whole country those provisions for such supply, as have been referred to under the head of Local Author itative Action.

The existing laws relative to the drainage of towns and the purification of watercourses, require entire revision, and cannot too early come before the Legislative Chambers of our own and other countries for that purpose.

small-pox, vaccination, disease, diseases, inoculation, vaccinated and children