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§ 2. These objects, or most of them, were originally carried into effect by several classes of Public Vaccinators, "Stationary, Extraordinary, and Corresponding." The only salaried, and therefore the only legally responsible, officers were the "Stationary" Vaccinators of London, originally twelve in number, and at the present time sixteen. They were located in metropolitan and suburban districts, and required to vaccinate gratuitously all applicants, to keep up a succession of cases, and from them to furnish the central depôt with regular supplies of lymph. The other classes of vaccinators need not now be described. No notice is taken either of the "Extraordinary" or of the "Corresponding" Officers in recent programmes of the establishment.

The duties of the Board of Management gradually diminished, until they consisted merely in the preparation of an annual report to the Secretary of State. Of these reports it is impossible to speak satisfactorily, and the general opinion of scientific men respecting them, may be given in the words of an able professional critique on the Report for 1828.

"When we consider the mass of information which must necessarily be possessed by the Vaccine Board, we acknowledge that we cannot but look upon their reports generally, and the present one in particular, as wonderfully meagre and unsatisfactory. There are many questions connected with the subject which are of the highest pathological interest and of the most urgent practical importance; yet these are seldom referred to in the reports, which are for the most part limited to a few general assertions with regard to the 'protective influence' and 'wider diffusion' of vaccination, with an occasional, unwilling, and qualified admission that cases are 'very often' reported, in which small-pox has occurred after cow-pox. But from a Board, comprising the highest medical authorities in the country, expressly established for the purpose of constantly watching over the progress of vaccination, and annually presenting to Parliament a Report, by which they and the public at large might be enabled to form a judgment upon a subject which is more or less interesting to every member of the community, we expect something more than this. We expect some account of the grounds on which the general conclusions have been furnished; and we expect that the great questions which at the

BB

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PARLIAMENTARY COMMITTEE, 1833.

time press upon the attention of professional men, and cause anxiety in the public mind, should be met and candidly discussed.

"It is remarkable, however, that the Vaccine Board, instead of leading public opinion, follow in the wake; and it scarcely ever happens that they allude to the difficulties which surround any portion of the subject, until they have long excited the notice and been eluci dated by the investigations of private practitioners. We do not look upon this as the fault of the individual members of the Board, but of its original and primary constitution. Men at the summit of professional eminence, and overwhelmed with business, cannot give to the subject the time and attention it requires; nor, on the other hand, can they whose connexion with the Board is but of a temporary nature, be supposed capable of entering, with much prospect of advantage to themselves or others, upon investigations, their immediate interest in which must terminate before they have become fairly acquainted with the subject-yet of these dissimilar and inefficient parts is the National Vaccine Board composed."*

§ 3. The Board originally consisted of eight members, a director, a registrar, and a secretary. The number of ex-officio members was from time to time reduced at the suggestion of the Secretary of State, and in 1832 was fixed at three, the present number.

Whether from discontent with "the meagre and unsatisfactory" annual reports, or from some suspicion of the sinecurism of the Board, or from general motives of economy, a select Parliamentary Committee was appointed in 1833—“To inquire into and report on the expediency of continuing the National Vaccine Institution." The Report of this Committee displays a thorough investigation of the subject. It is replete with historical information and many interesting practical details, well deserving attention even at the present time. The following were its chief recommendations :

That the Board should for the future, consist of two Physicians and one Surgeon; all members of the profession to be eligible, and the appointments to be made by the Secretary of State-that the Board should appoint an Inspector, to super

*London Medical Gazette, vol. i. p. 507.

PRESENT DUTIES OF VACCINE BOARD.

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intend the vaccinations and attend to the distribution of lymph; and a Registrar to conduct the correspondence, and, in case of the Inspector's illness or absence, to officiate in his place:that, as the duties of the Board would for the future be rather honorary than troublesome, the members, before their appointment, should signify their consent to superintend the executive officers, and to make the annual reports, gratuitously;—and that the annual charges should be reduced from 23211., as in 1832, to 16051.

The House of Commons, however, still sanctioned the salary of 100l. per annum to each member of the Board, and the appointment of the ex-officio authorities who now form it, acquiesced in the proposed limitation of its duties, and confirmed the recommendation of the Committee respecting the other officers.

§ 4. From that time, the essential duties of the National Vaccine Establishment have consisted in collecting, carefully registering, and promptly distributing gratuitous supplies of vaccine lymph to all parts of the empire, by means of one Inspector and Vaccinator, sixteen stationary Vaccinators, and a Registrar. Its objects are therefore to promote efficient vaccination, by directing its careful and scientific performance at the London stations, and by an extensive circulation of the lymph thus obtained.*

With reference to the necessities of the public, the defects of the National Institution were,-that its stations and officers were confined to the metropolis, that it was constituted without any definite administrative authority, and that the Board of Management consisted of gentlemen in high professional position, who might happen to be practically acquainted with the details of the subject, but who were not selected on that account.

* The Small-Pox Hospital and the London Vaccine Institution, or Jennerian Society, although supplying lymph very extensively, are not here mentioned as State establishments, because their incomes were derived entirely from private contributions.

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PROVINCIAL ARRANGEMENTS.

§ 5. What, then, at that time, was the state of the provinces with regard to public vaccination? As regards a permanent supply of lymph, they were chiefly dependent on the London As regards executive arrangements, they were institutions. wholly dependent on the philanthropy and intelligence of old But, whatever amount of apathy and parochial managers. stolidity these might have often evinced, their more ready perception of danger, when small-pox threatened their own families and immediate neighbourhoods, led them, in many places, to arrange periodically with the parish doctor for the vaccination of the poor.

Thus, before the enactment of the new poor law, the churchwardens and overseers of probably more than half the parishes in the kingdom were in the habit of directing a general vaccination of poor children, either annually, or on the threatening of a small-pox epidemic.

But, after the reform of the Poor Laws, parochial vaccinations became less and less frequent; and the subject, in its local bearings and interests met with but little attention from the Boards of Guardians. Small-pox became far more prevalent and fatal. The deaths from this loathsome disease, in 1838, amounted to more than 16,000 in England and Wales, and to 3800 in London alone, or more than four times its average rate of mortality.

The effect of vaccination, as a permanent safeguard against small-pox, became to be more and more doubted by the people. Medical observers noticed some modification in the normal character of the vaccine vesicle and in its accompanying constitutional disturbance as described by Jenner.* It was generally believed that re-vaccinations took effect more frequently, and it was therefore thought that they had become more necessary.

§ 6. The anxieties of the nation and the Legislature were roused; and the admitted necessity for State intervention led to the second stage of public vaccination—namely, the enactment in 1840 of a law for its extension (generally known as Lord * See Mr. Estlin's opinions. See Supplementary note H.

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Ellenborough's Act), which applied to England, Wales, and Ireland, but not to Scotland.

The principal provisions of the Acts of 1840-41, have been thus described by the Epidemiological Society:

"i. Boards of Guardians are authorized and required to contract with their medical officers or other practitioners, for the gratuitous vaccination of all persons resident in their respective unions or parishes, the expense being defrayed out of the poor-rates.

"ii. A copy of the contract so made is required to be transmitted to the Poor-Law Board, who have the power, within the period of fourteen days of the receipt of the contract, to annul the same if they see fit.

"iii. The Poor-Law Board are empowered and required to issue regulations which are binding on the Guardians.

"iv. The public vaccinators, appointed as above, are required from time to time to report the number of persons vaccinated by them. The practice is, that the books of the vaccinators are laid before the Guardians at each of their meetings, which are held weekly or fortnightly.

"v. Inoculation with variolous matter is declared to be an offence punishable by imprisonment for any term not exceeding one month. "vi. Vaccination as performed under this Act, is declared not to constitute parochial relief or alms."*

§ 7. I have already shown (Essay IV.) the extreme inconsistency, on grounds of political economy, of committing a measure of sanitary police like public vaccination to authorities. constituted merely for the control and relief of pauperism. But, the remarks on this subject, contained in the last memorial on Vaccination by the Epidemiological Society, are so much to the point, that I shall probably be excused for quoting them here at length:

"It is manifest, in the first place, that the vaccination of the people, which is a measure undertaken by the State for the security of the public, has nothing in it of the character of alms, and does not fall properly under a department of Government, whose sole function is the distribution of alms; while it is equally obvious that it does fall naturally under a department charged with the maintenance of the