, in rising to call attention to the Small Pox Epidemic in London; and to move—That, in view of the alarming increase of Small Pox in London, this House calls upon Her Majesty's Government at once to apply to the Metropolis those rational principles of prompt and direct preventive administration, the efficacy of which in circumscribing Small Pox Epidemics has been demonstrated by the experience of Glasgow and other large towns,said, he should make" no apology for bringing a subject of such great importance under the notice of the House. The President of the Local Government Board had told them the other day that nearly 400 persons had died of smallpox in London during the present year, and that the mortality was 10 per cent; so that there must have been about 4,000 cases. Now, it might be said that there was nothing very alarming in that; but it was the way in which their experience told them how all epidemics commenced. There would probably be a decline in the mortality during the hot weather, owing to the plentiful ventilation which the warm weather promoted; but there would be a resumption of the virulence of the epidemic when the cold weather set in, and they might expect a serious epidemic in London next year. That was the case when the great epidemic of 1870–2 broke out. The mortality was much less then than it had been during the present year—not half the amount. In 1870 it was 1,000, and in 1871 it was close on 8,000. The same was the case with the epidemic of 1876–7, in the first year of which the mortality was not 1799 at a greater rate than it had been this year; also with the epidemic of 1880, when there was a mortality of 471, which was succeeded by a mortality of over 2,000 in 1881. The Metropolitan Asylums Board had recognized that fact, for they had accommodation for 1,600 small-pox patients, and were increasing that accommodation in view of next year. They had hired, he believed, a hospital at Poplar, and were endeavouring to purchase land for the purpose of establishing camp hospitals. The Local Government Board recognized the fact also, for in a Circular issued on the 23rd of June they recommended the appointment of assistant vaccination officers and house-to-house visitation. Now, the system proposed in his Motion was no untried system. In the present year they had had a small touch of this epidemic in Glasgow; but they had had only 10 deaths in 133 cases. The outbreak commenced last year; but the cases, instead of increasing from week to week as they had done in London, had been reduced from 10 to 5, and then almost extinguished. The population of London was about eight times the population of Glasgow; and if they multiplied the mortality in Glasgow by eight they would get the mortality which ought to have occurred in the London population, had the same system been adopted, with similar results. By the adoption of the Glasgow system they might have had a saving of 300 lives, and close upon 3,000 cases of small-pox in the present year. The British Medical Journal of January 21, wrote—To those who have watched this outbreak, and have read the detailed accounts of its progress given in the different fortnightly reports, it must he quite clear that the disease has been kept within bounds and its extension limited by the energy and vigilance of the members of the sanitary staff of the city. Their promptness in tracing cases and immediately isolating those affected, together with the judicious use of revaccination in the case of those exposed to infection, has undoubtedly been the means of saving Glasgow from a severe small-pox epidemic, such as is now taxing all the resources of the sanitary authorities in London.The total death-rate in Glasgow per 1,000,000 during the entire duration of the epidemic of 1870–4 was 1,560; while the mortality in London during the same period was over twice as much, or 3,287. If they worked out that, they would find that if the Glasgow results had been secured, they would have saved about 1800 3,000 lives and 15,000 cases in that epidemic. Let them take the entire 14 years between 1870 and 1883. The average small-pox mortality in Glasgow was 115 against 400 in London; and, working out the process, they would find that the saving of life during those 14 years, had the Glasgow results been secured in London, would have been close on 9,000, and that indicated a saving of close on 45,000 cases of small-pox. The Glasgow experience was not the only case in point. He might quote Manchester. During those 14 years, while London had an average mortality of 400, the average in Manchester had been 160, against 115 in Glasgow- Taking the figures for 10 years, from 1874 to 1883, the average annual mortality from small-pox was—In London, 234; Manchester, 82; Glasgow, 46; Leeds, Old-ham, and Bradford, 42. This was not a matter of merely local importance; it was a matter of great national importance, for they were constantly sending out the disease to affect other parts of the country. What was the reason of the difference? It was simply a case of the efficacy of direct action as contrasted with circumlocution. He would explain to the House the difference between the London and Glasgow system by three illustrations. Let them take a can of dynamite with a fuse a yard long burning in it. According to the Glasgow system, the policeman who discovered it would think it his duty to pull out the fuse and put an end to the whole thing. In London, taking the small-pox analogy, the duty of the policeman who saw the fuse burning would be to report the matter to Scotland Yard, who would report to the Home Office, who would consult the Home Secretary, who would order out some officer to pull out the fuse, by which time, of course, the explosion would have taken place. Or, take the case of a mad dog, a constable at Glasgow would kill it; but in London it would be his duty to report to the parish authorities, who would report to the veterinary authorities, who would send a veterinary surgeon, who would report to the Local Government Board, who would issue a Circular calling attention to the risk of hydrophobia, and recommending the establishment of a hospital for patients. The third illustration was the cattle plague, in which the same difference between direct action and circum- 1801 locution would be observed. Glasgow laboured under great disadvantages in regard to small-pox. It contained a number of tenement houses, in which 100 families or more were often housed. From 1855 to 1864 the mortality from smallpox per 1,000,000 in Glasgow was 570, against 232 in London. But in 1863 a change was introduced. They had a very intelligent Medical Officer of Health, Professor Gairdner, who laid down the maxim that—Vaccination should be not only freely offered but systematically pressed upon the inhabitants of the neighbourhood, as well as of the immediately infected houses.And he directed the arrangements to be made. Now, in Glasgow they had none of the costly vaccination paraphernalia of London. Glasgow was much worse vaccinated than London—at all events, they had no army of Inspectors, and their vaccinators did not participate in the premiums paid to vaccinators for doing their duty, at a cost to the country of some £15,000 a-year. They had no vaccination stations kept up out of the Imperial funds. But everything was under one man — Dr. Gairdner —the result being that in the 10 years in which the system had been adopted the Glasgow death-rate from small-pox fell from 570 to 194; whereas the London death-rate increased from 232 to 470. A new Medical Officer stepped into power—Dr. Russell—one of the most energetic and sagacious Medical Officers in the whole Kingdom; and that gentleman found a flaw in the system that had been adopted by his predecessor—When I entered on office, "he said, "in 1872 and in the spring of 1873 small-pox again became epidemic. I saw that the system of making a note of persons ready to accept vaccination and then going with a doctor next day was not successful, while if at the first visit the operation was offered it was accepted largely. I therefore had the epidemic officers all trained, and made Dr. Carmichael responsible for the collection and supply of lymph, and any primary vaccinations necessary.The result was that from 1874 to June 5, 1883, they had had only 45 deaths from small-pox in Glasgow. Multiplying those figures by eight would give them 360 deaths in a population equal to London; but the actual number of deaths in London from small-pox during the same period was 8,989, or 8,629 more than it should have been on the Glasgow ratio, and that number of deaths 1802 signified 45,000 cases of small-pox. The expense at which these satisfactory results had been obtained was, as Dr. Russell had said, trifling. Dr. Carmichael got some £80 per annum. The revaccination was simply an extra accomplishment of the epidemic Inspector. The expense saved had been very great. He ventured to say that the law expenses which had been forced upon the Metropolitan Asylums Board had been 1,000 times the salary of Dr. Carmichael; and the cost of providing hospital accommodation, and treating the 45,000 eases which had arisen in excess of what should have arisen, must have been many thousands of times as great. The hospital accommodation provided by the Metropolitan Asylums Board was 1,600 beds. The Commission which a couple of years ago reported on Small Pox Hospitals stated that there should be accommodation for 2,100 small-pox patients, capable of increase to 2,700. In Glasgow, since the system had been in full swing, the highest number of persons that had ever been in their hospital was 40. Now, that was the system that he wanted to be adopted in London. His hon. and learned Friend the Member for Stockport (Mr. Hopwood) deprecated despotic action in this matter, "calculated to wound the affectionate feeling of the suffering poor;" but his hon. and learned Friend must be under a misconception as to what he really proposed. He did not advocate any new compulsory power; he did not ask for any compulsory notification of disease; he did not advocate any new vaccination system. He simply advocated the rational application of the existing machinery. By such application thousands of lives might be spared, tens of thousands of illnesses, and many a pang of the affectionate feelings of the suffering poor, and also of the suffering rich. He asked the President of the Local Government Board to give effect to the dictum of Dr. Seton, the Medical Officer of his own Department, that nowhere where due vigilance was used need small-pox spread. In London, unfortunately, it was nobody's business to do anything effectually in respect to the prevention of small-pox. The only thing that was done well in connection with the matter was the sending of Reports from one Office to another, and issuing circulars and handbills. He might be told that 1803 first-class arrangements were made for the isolation of the sick by the Metropolitan Asylums Board. He admitted it; but it was not their business to make that provision. The Board administered funds supplied by the poor rate, and they had no right to allocate Is. of those funds to the maintenance of free hospitals to persons who wore not paupers. The Local Government Board had been repeatedly asked what was the law upon the point, and they had as repeatedly refused to answer the question, because they knew that if they answered they must say that the Metropolitan Asylums Board had no right to expend that money in securing such isolation in cases of small-pox. Now, coming to revaccination, the Local Government Board maintained vaccination stations in the Metropolis at the expense of the nation; but as soon as an epidemic of smallpox arrived, the universal complaint was that there was no lymph. Among the witnesses who gave evidence on this point before a Royal Commission was Mr. Shirley Murphy, a gentleman at present employed in the National Calf Lymph Establishment of the Local Government Board, and the same evidence as that given by him was also given by Dr. Browning, the Medical Officer of Health of Rotherhithe, and it exactly accorded with his (Dr. Cameron's) own experience. He had come across a Medical Officer who, to put down small-pox at his own expense, opened a vaccination station, where persons could be revaccinated gratis at a certain hour every day in the week. A great number had availed themselves of it; but he had to give it up because he could not get any lymph. It was not the business of the Local Government Board to supply lymph. In 1880, after having pressed the matter for a good number of years, he (Dr. Cameron) had succeeded in getting the right hon. Member for Scarborough (Mr. Dodson), then President of the Local Government Board, to introduce and start a calf-lymph vaccination station in London. Well, what occurred then would illustrate the whole policy of the Local Government Board in this matter. The subject had excited a great deal of attention abroad. In Holland they had introduced the system of calf-lymph vaccination stations. They were worked there with great success; and so interested were the Dutch medical men 1804 at the head of the system in the effort being made to establish it in this country, that they sent over a representative here—Dr. Van Dooremal—to wait upon the Local Government Board, with the offer that, if the Government would pay the bare outlay, they would come over and undertake to start the system, and for some time direct its working. He had the information from the gentleman himself. Well, the Local Government Board refused that offer. First, they would do nothing until one of their officers had made a tour of the Continent to visit the different calf-lymph establishments there; and then they kept the country waiting for 12 or 18 months before they established a calf-lymph station for themselves, because, forsooth, they could not get a stable in which to stable two or three calves in all London! That was a positive fact, and that was in the face of the epidemic of 1881. The cry then everywhere was that there was no lymph. Human lymph could not be multiplied, but calf lymph could. In economical Belgium a single calf would produce lymph enough to supply 500 persons; and the calves might be hired by the week for 10s., and afterwards returned to the owner, and after a short time become lit to be fatted and killed, so that in Belgium 500 persons might be vaccinated for 10s., or about one farthing a-head. Suppose they were twice- as extravagant, they might still vaccinate with calf lymph at a halfpenny a-head. In London, notwithstanding the expenditure on national vaccination, no effective means were taken for supplying lymph. It was nobody's business. In Glasgow they had no grant from Government; but their Municipal Authorities and their Medical Officer of Health knew that they had to deal with smallpox, and, knowing that, the Municipal Authorities at their own expense kept up a vaccination station for their own supply. In London, the Imperial Exchequer paid half the expense incurred by the Metropolitan Asylums Board in the treatment of the pauper sick, including, of course, small-pox cases also. During the epidemic of 1881, a servant man of his in London, living with his family in a house with 20 other people, had been seized with small-pox. As he was not a pauper he could not be removed to the workhouse hospital, and he (Dr. Cameron) was himself glad to secure the 1805 man's immediate admission to Highgate Hospital on payment of £4 4s. But if that man had been friendless he might have been left in that crowded house, as far as any action of the medical or sanitary authorities went, and have thus spread an epidemic first among the other occupants of the house, and from them throughout the neighbourhood. He (Dr. Cameron), on that occasion, asked the Medical Officer of the district if he would look after the revaccination of the other people in that house, and that gentleman replied that it was not his business to do so; but that what was his duly he would do—to report the outbreak to the vaccination officer, who in turn would communicate with the public vaccinator. But he afterwards discovered that nothing was done. The custom was, it seemed, for the public vaccinator to issue bills over the neighbourhood during the presence of smallpox, actual or apprehended, intimating to those of the public who desired to get vaccinated to attend at a certain station, possibly two or three miles distant, at a certain hour on a certain day, when they could have the process performed. The consequence of such a course in dealing with a matter requiring the most urgent promptitude was that the system necessarily failed as a preventive one. Vaccination to be an effectual remedy against the disease must be prompt. Vaccination ran its course more speedily than smallpox, and, overtaking or anticipating it, it exhausted the pabulum upon which small-pox fed before the disease had time to develop. But if delayed for four or five days after the infection, then vaccination was useless to arrest a disease which had already taken hold; and, in such circumstance, the vaccinator might save his trouble. In Glasgow vaccination or revaccination was performed on the spot to everyone requiring it. In the last epidemic in Glasgow, in a tenement containing 66 families, a case of small-pox occurred, and it was not discovered to be small-pox until after the death of one of the persons. Then 24 of the occupants had caught the contagion. When the Medical Officer of Health had visited the place, upon discovering the nature of the disease, he had the 24 persons removed, the other persons, to the number of 152, revaccinated, and the place disinfected. From 1806 the first case 24 cases had arisen. From those 24, promptly dealt with, not a single case of infection occurred. In the present epidemic in Glasgow there had occurred 133 cases, and 1,100 persons had been revaccinated. Upon asking the President of the Local Government Board what the system in London was, he was told what had to be done was that the vaccination officer, with such assistance as the Poor Law Guardians might give him, made detailed visits to the houses and streets infected for the purpose of detecting unvaccinated children and urging on the people to have themselves and their children revaccinated and their houses disinfected. Now, that was a system which they would not submit to in Glasgow. Such a system was too inquisitorial. The object of those visits was to urge the people to present themselves without loss of time at the vaccination station, where revaccination would be successfully performed if they attended. It was a very good system in theory, but defective in practice, because the people neglected to comply. Handbills and placards were issued informing people where and when the operation would be performed gratis; but the place was too often at a great distance from the people's homes, and' the consequence was that frequently they did not go. In London the persons who were revaccinated were not, for the most part, the persons who had been exposed to infection, and whom, in the public interests, it was most desirable to revaccinate. Prior to Dr. Russell's— the Glasgow Medical Officer of Health —time experience showed that if a single day were allowed to elapse between the chance of infection and vaccination, the probabilities were against the persons infected voluntarily submitting to vaccination. In Glasgow, therefore, revaccination was offered at the time and on the spot. In the last epidemic he had found that, if a supply of lymph could only be insured, a number of Medical Officers of Health were willing to undertake the work of revaccination. It was asserted that District Medical Officers of Health were allowed to perform the duty; but the all but nominal fee payable only in the case of adults and only in successful cases, which were two out of three, would not reimburse them the cost of the lymph, to say nothing of remunerating them for their 1807 trouble. A Medical Officer of Health told him that on the removal of a case of small-pox from a house he told the inmates that they would be revaccinated if they would go to the vaccination station at a certain hour on the Monday or Tuesday following; but if days elapsed vaccination would be, in most cases, a mere farce. If any of the persons had taken small-pox it would be too deeply rooted in their constitutions to be checked; and the result would be that they would be sowing the seeds of infection among the mothers and children assembled at the station. While in Glasgow 95 per cent of those revaccinated were the persons whom it was desired on public grounds to have revaccinated, in London probably not 5 per cent came within that category. Dr. Bonney had mentioned to him, as a forcible illustration of the working of the London system, the case of a tailor whom he found laid up with small-pox, and having seven pairs of trousers hanging in his shop ready for pressing. These the doctor could not himself order to be disinfected, but had to communicate with the Medical Officer of Health. Ultimately the trousers had been sent home before this functionary appeared on the scene, and some of them might possibly be wearing by hon. Members of that House. The disease was propagated in a similar way by laundresses and hucksters, whose clothes and goods were dispersed before the machinery for disinfecting could be got into operation; and yet people told you that isolation, revaccination, and disinfection was carried out, and wondered why small-pox should spread. A case, illustrating the circumlocution and delay of the London system, occurred at the institution in the parish of West Ham.
No; it was on Wanstead Flats, on the outskirts of London, and was practically a part of London, and whatever affected that district, in the way of infectious diseases at all events, would affect London. It appeared that in the early part of last month three of the girls in this institution were found to be suffering from small-pox. Anxious to have them removed to an infectious hospital, the gentleman who reported the case applied to the vaccination officer, who referred him 1808 to the relieving officer, who referred him to the Medical Officer of Health, who could do nothing. He then wrote to the President of the Local Government Board, who wrote that an official reply should be sent. He next went to the Asylums Board Hospital at Homerton, whence he was referred back to the vaccination officer, and ultimately he had to apply to a "pay hospital" at Highgate, where the patients were taken in; but even there they had no ambulance, and he was obliged, next, to go in search of an ambulance, which he found at Netting Hill. In these proceedings a whole week was occupied, to the great danger of the spread of the disease throughout the whole institution, and a considerable number of cases occurred. In Glasgow the responsibility for all necessary action, as regarded both the suffering and the possibly infected, was concentrated upon one Authority, and all the prescribed processes were promptly carried out. The disinfection of a room might involve the destruction of the paper on the walls; but it was not obligatory on the Local Authority in London to repaper the room, and, therefore, proper disinfection was often evaded. This was a source of danger that would be lessened if a process, submitted to compulsorily on public grounds, were followed by the repair of any damage that was unavoidable. The Royal Commission, of which they remembered, recommended that the whole business of dealing with small-pox cases should be handed over to the sanitary authorities. They went far beyond what he asked on the present occasion. They had recommended the compulsory notification of infectious diseases. He did not ask for that on the present occasion. They made some important recommendations as to isolation, and these had been carried out. In accordance with their recommendations, the Metropolitan Asylums Board had taken over the ambulance system, and they had established hospital ships—the Atlas, Castaliâ, and Endymion, and the camp at Darenth. He could not help thinking it was a pity that the Commission did not visit some of the large towns where the disease had been successfully grappled with, and see what was being done there; and it was still more of a pity that Dr. Buchanan had not made himself acquainted with what had been done in these towns, so that 1809 he might be able to tell the Commission. If they had gone to these largo towns they would have found that the success elsewhere was greatly owing to the fact that isolation, notification, and revaccination were taken hand-in-hand and applied concurrently. Isolation, disinfection, and revaccination must be worked together. In consequence of the neglect of the two latter in London during the last epidemic, the means of isolation were insufficient; and, notwithstanding what had now been provided, the cry was still for more camps and more hospitals. He did not ask the President of the Local Government Board for any inquisitorial system. Let him authorize a free supply of lymph and the payment for prompt revaccination of infected households. Let him authorize the Metropolitan Asylums Board to spend money in this matter, as he authorized thorn to illegally expend money on the isolation of non-pauper cases. The House would protect the Board from any loss. They would provide an indemnity for the small sum that would be needed. If the President of the Local Government Board must have legislation, let him provide for giving lymph and a moderate fee for prompt revaccination of infected households during epidemic; let him constitute District Officers and Assistant Medical Officers of Health; let him legalize what was non-illegal—the reception of non-pauper cases into the hospitals of the Metropolitan Asylums Board—and let him provide for the payment for articles destroyed. That would save the house-to-house visitation which prevailed in London; it would save those willing to get revaccinated the trouble of going to the vaccinating stations; it would save any increase in hospitals, ambulance, and additional vaccination stations and officers. In Glasgow they had applied the same principles as had been applied in London, and the only difference was in the mode of administration. He had repeatedly urged during the last epidemic that something should be done. The President of the Local Government Board admitted an urgent necessity for reform; but what he wanted to do was to wait until the passing of the London Government Bill enabled him, with greater facility, to carry out the recommendations of the Commission. If he waited until the London Government 1810 Bill passed he might have to wait for a very long time. They knew what fascination was exercised by snakes over birds. It seemed to him that permanent officials exercised a similar power over Ministers. His right hon. Friend proposed to move the Previous Question to his Resolution on the ground that he objected to "swap horses while crossing the stream." So did he. What he wanted simply was to utilize the present machinery. As he had said, most of what he asked for could be accomplished by a stroke of the pen; everything he asked could be done by Government assuming responsibility for a few thousand pounds. No great courage was needed here, and he was sure an indemnity would be given. They rather shirked responsibility; but if they did not want to take any responsibility in the matter, the legislation would not be half so difficult to carry as the Cholera Prevention Bill. He had explained what he wanted to the right hon. Gentleman and to the officials. The right hon. Gentleman admitted what was wanted, but the officials were adverse to any change; and the officials being adverse, the President of the Local Government Board asked them to postpone the whole matter till the London Government Bill passed. He supposed when a few more epidemics had swept over London, and the right hon. Gentleman the President of the Local Government Board was in Opposition, he would advocate what he (Dr. Cameron) was strongly urging in this matter. In the name of humanity, he implored his right hon. Friend to think, and judge, and act for himself. Let him, by all means, accept the advice of medical experts on purely medical points. The principles laid down by his advisers were precisely the principles they had adopted in Glasgow. But let the right hon. Gentleman trust his own common sense for administration in a matter of the greatest importance. In the presence of a great emergency—the almost certainty of thousands of deaths next year, should present arrangements continue— he had to beg and implore the right hon. Gentleman to cast resolutely aside that fussy and expensive policy of "how not to do it" that had so long prevailed in London. Let him burst asunder the humilitating trammels of red tape, assert himself as Minister of Health, and "stand between the living and the dead, and 1811 stay the plague." The hon. Gentleman concluded by moving his Resolution.
§ DR. FARQUHARSON
seconded the Motion of his hon. Friend, not in a spirit of hostility to the Government, but rather in a spirit of candid criticism. It was of the utmost importance that their institutions, from time to time, should be examined and taken to pieces, to see whether they were in harmony with the circumstances of the age in which they lived. Although his hon. and learned Friend the Member for Stockport (Mr. Hopwood) deprecated the use of alarming statements on the approach of smallpox and other epidemics, as likely to create panic, he believed that a discussion on the subject raised by his hon. Friend the Member for Glasgow would do good. It was very disheartening to the advocates of vaccination to see these epidemics sweeping over the country from time to time; and a great encouragement was often given to those anti-vaccinators who were doing such great and irreparable damage throughout the country. These epidemics which appeared from time to time showed that the protection they had at the present time was still insufficient. The question then arose, whether the protection was insufficient in itself, or whether the machinery was not properly worked? They knew perfectly well that, in all great epidemics of small-pox, those who were properly vaccinated escaped altogether or slightly. He wished to pay a tribute to the efficiency with which the private vaccination of this country was conducted under the supervision of Dr. Buchanan and Dr. Seton of the Local Government Board, through whose exertions the proportion of unvaccinated children was now reduced from 10 to 4 per cent. The question might be put, why did they have these serious epidemics, and why did one case cause the disease to spread to such an extent? The fact was, there was still a very considerable number of unvaccinated people, and of people who had been insufficiently vaccinated. He could not too strongly advise revaccination. There was no doubt that a person who had been, vaccinated in childhood ought to be revaccinated after a certain number of years. There was but very little inconvenience in the operation, and he should like to see revaccination made compulsory in this country. To stamp out small-pox 1812 altogether they must have early detection, and they could not have early detection in an efficient degree unless they had a compulsory system of notification of disease in this country. The extent to which small-pox was concealed in London was appalling. There must be prompt and thorough disinfection, and prompt revaccination of infected households. His hon. Friend had pointed out that the machinery in London was very defective as compared with that of Glasgow, where the system was under the superintendance of Dr. Russell; and he thought it only reasonable to give a trial to the better system. Several eminent witnesses before the Royal Commission recommended that the matter should be placed under the direct control of the Local Government Board, instead of under that of the Guardians, and that suggestion he thought worthy of consideration. He thought the question of the cause of epidemics was one which would well occupy the attention of the Local Government Board. They had a most able and most experienced staff, although it was, perhaps, already overworked. He hoped that the President of the Local Government Board was prepared to say something in this direction.
Motion made, and Question proposed,
That, in view of the alarming increase of Small Pox in London, this House calls upon Her Majesty's Government at once to apply to the Metropolis those rational principles of prompt and direct preventive administration, the efficacy of which in circumscribing Small Pox Epidemics has teen demonstrated by the experience of Glasgow and other large towns —(Dr. Cameron.)
§ SIR CHARLES W. DILKE
, in moving the Previous Question, said, that he rose as against his hon. Friend the Member for Stockport (Mr. Hopwood), who had an Amendment on the Paper, because he did not think it advisable that the House should divide upon the Motion before it. The question had been brought before the House as one of practice only, and not as a question of principle, as the principles of the Mover appeared to be the same as those of the Local Government Board. The hon. Member had not, however, placed it before the House in that scientific way which might have been expected from one of his high scientific attainments. He had compared the cases of London and Glasgow, and had 1813 spoken of the high mortality in London in very general terms, as if in the Metropolis alone the mortality was high. But he would remind the House that it was not alone in London that the mortality from small-pox was high. The same system prevailed throughout England as prevailed in London. That was one of the faults which he found in the speech of the hon. Member. The hon. Member for West Aberdeenshire (Dr. Farquharson) had not really said much as to the Motion he was seconding. He had made a useful and valuable speech upon small-pox generally and its statistics; but he had certainly said little in support of the Motion of the hon. Member for Glasgow. Now, if he (Sir Charles W. Dilke) were inclined to be facetious on a serious subject, he should say that the Mover and Seconder were only agreed in the matter of trousers; and, considering that these Gentlemen hailed from the Northern portion of Her Majesty's Dominions, he should say they were animated by the patriotic intention of altogether abolishing those articles of attire. Passing to the Motion itself, he would readily admit that there was in London, as compared with the Provincial towns, a high rate of mortality. At the same time, in many Provincial towns the mortality was very high indeed. Liverpool, for instance, suffered greatly from smallpox; and he thought that it could be shown that under a single Sanitary Authority they could have a very serious state of things existing as regarded small-pox. He did not think, therefore, that the hon. Member for Glasgow was justified in picking out the case of London as standing by itself. In Paris, he might parenthetically observe, the death-rate from small-pox was greater than in London. If the hon. Member for Glasgow were only prepared to contend that there was room for improvement in the sanitary arrangements of London, and in the Sanitary Authority of London, he was perfectly prepared to agree with him. It was one of the points urged by the Home Secretary, when introducing the London Government Bill, that unity in sanitary administration in the Metropolis was a thing very much to be desired. The hon. Member said it was nobody's business to do anything effectively. Well, he was sorry to say that statement was too much applicable to 1814 London Government generally. The Local Government Board had gone as far as their powers extended to awaken the local authorities to a sense of their duty. Where Guardians had failed to provide accommodation in connection with small-pox, the Local Government Board had done their best to induce them to supply it. At the same time, he must observe that his hon. Friend did not seem to be thoroughly acquainted with the English vaccination system as contrasted with the Scotch system. The hon. Member had spoken of a contribution of one-half the expense from the Imperial Exchequer; but there was no such provision as he had described. More than that, he had given illustrations from the parish of Chelsea, and had declared that between the vaccination stations a distance of two or three miles intervened. That statement did not correspond with facts, because he would undertake to say that the distance was not greater than half-a-mile. Then the hon. Member had said that the District Medical Officer should be paid for the revaccination of persons in infected houses. As a matter of fact, they were paid for it. The hon. Member had, moreover, alluded to the case of a gentleman who had written certain letters to the newspapers and to the Local Government Board, and he had complained that, in face of the fact which the correspondence disclosed, the Local Government Board had refused to act; but the hon. Gentleman knew that that case occurred outside the limits of the Metropolis; whereas, as a matter of fact, there was no power at law to warrant the interference of the Local Government Board. In London, as he had pointed out to his hon. Friend in the month of May—although his hon. Friend now made the reply he then gave to his Question a matter of complaint—the great proportion of the cases of smallpox were dealt with by an authority which required, by Act of Parliament, to be set in motion by District Medical Officers, as distinguished from Medical Officers of Health. In Glasgow the first medical observer of a case of small-pox was usually the Medical Officer of Health; whereas in London it was the District Officer who became, as a rule, soonest aware of the occurrence. The hon. Member stated that in many cases 1815 the vaccination stations were distant from the homes of the poor. As a general rule that was not so; and although some difficulty had been experienced in the case of Hackney in inducing the authorities to provide evening vaccination places, and though there was great delay in that case in carrying out the suggestion, yet many parishes had shown themselves eager to adopt every scientific precaution against the disease. The hon. Member did something like justice to the stops taken by the Metropolitan Asylums Board in their action upon the Report of the Royal Commission; but he seemed to imply—although he did not state his alternative — that the action of the Board was unnecessary.
I did not say that. What I said was, that so much accommodation would be unnecessary if proper preventive steps were taken in the first instance.
§ SIR CHARLES W. DILKE
Very well; he would not go into that. But the House must remember that there was a large shifting population, and also a largo foreign population, in the Metropolis, and it was not easy to secure their vaccination; and it was among them that the disease frequently appeared. But the hon. Member raised a much larger question than that merely of small-pox vaccination when he suggested that the vaccination arrangements should be transferred from the Boards of Guardians to the sanitary authorities. His (Sir Charles W. Dilke's) own view was that, in London at all events, it was a great mistake that the sanitary care of the town should be divided, as it was, between three sets of authorities. Both with regard to small-pox and all other diseases it would be far better to concentrate the sanitary arrangements in a single authority. His own opinion in that matter was shown in the Cholera Bill he had introduced last year, in which one Sanitary Authority was provided for the whole Metropolis in connection with any outbreak of cholera that might occur. At the present time they had 39 distinct authorities. The hon. Member rather ridiculed the idea that such a matter could wait until the Bill dealing with the Government of London was brought forward. But it was impossible to treat this matter in anything like a satisfactory way unless in a measure embracing the whole ques- 1816 tion of the Government of the City of London. He could not admit that his hon. Friend had made out any case for the substitution as regarded this one matter of one set of authorities, 39 in number, for another set of authorities equally numerous. The hon. Member had spoken, too, of rational and scientific principles in dealing with small-pox by vaccination and revaccination, and had said that it was not the principle but the administration with which he quarrelled. While he was not by any means prepared to contend that the state of things in London was in practice perfect, or anything like perfect, he would point out that when, for the purpose of actual results, they compared London with Glasgow, it seemed to be exceedingly good. In Kensington, in 1881, there was house-to-house visitation throughout the parish, a vaccinating officer with six assistants being specially engaged for the purpose. The greater part of the work was done in five weeks, the whole taking rather more than three months. As the result, 1,127 primary vaccinations and 2,156 revaccinations were done at the appointed stations, making a total of 3,283 for the parish, with its population of 120,000, against an average of 720 in the similar space of time of an average year. They were done at two stations, including one temporarily opened for evening attendance, and were done in such a manner that on case was unsuccessfully operated upon. The hon. Member said that in Glasgow 100 persons were vaccinated and 362 revaccinated in a fortnight; and that in the epidemic period, which lasted four years, the Officer of Health and his assistants vaccinated 4,406 and revaccinated 8,730 persons. But Kensington, under similar circumstances of of urgency, could, and did, vaccinate and revaccinate even larger proportions of its population. The hon. Member had charged him with being under the fascination of his own Medical Department; but the fact was, that the action he had taken was without advice from anybody, and entirely on his own responsibility. The hon. Member had suggested the use of calf lymph when humanized lymph was not available. There was, however, considerable objection to the use of calf lymph. In the first place, as compared with humanized lymph, calf lymph was much less easy 1817 of removal from the "points;" it did not take with the same degree of certainty; in addition to which it soon lost its virtue, and great waste and expense would consequently be caused by its employment. His hon. Friend seemed to think that no good was done by house-to-house visits; but the fact was, a large amount of vaccination and re-vaccination had taken place through house-to-house visitation. The "station" vaccination had also been largely done, and done as a rule more efficiently, and also more cheaply, than by the house-to-house system. In the circumstances, he did not like to ask the House to negative the Motion of his hon. Friend, because there was, undoubtedly, existing a state of things which was not satisfactory. It was not, in his view, desirable that whilst the small-pox epidemic was raging they should during its course change the administration of the Acts. Under these circumstances, he begged leave to move the Previous Question.
§ Previous Question proposed, "That the Original Question be now put."—(Sir Charles W. Dllke.)
§ MR. ANDERSON
said, he had frequently listened with much delight and satisfaction to the speeches of his right hon. Friend on foreign affairs; but he regretted that on the present occasion he had listened to his speech with the very reverse of satisfaction. He thought it was in the highest degree unsatisfactory. The right hon. Gentleman did not traverse a single important statement of his hon. Colleague, but took out some little points—such as the distance to the stations from the residences of the people —and spoke about calf lymph. But he did not attempt to touch any of the main points of his argument. The right hon. Gentleman had referred to the case of Liverpool; but the state of Liverpool, instead of being a justification for London, only furnished another example of a bad system—breaking down when badly worked. Why had he not quoted Manchester? Glasgow was not the only large city where things were well managed. No allusion whatever had been made to Manchester, which was a great town, and where great and good results had been brought about. The right hon. Gentleman endeavoured to make the House believe that the state of some 1818 districts of London was as good as that of Glasgow, and mentioned Kensington in proof of that statement. But what were the facts? Between 1877 and 1881 the mortality in Kensington was 226 per 1,000,000. In Glasgow, between 1875 and 1884, it was 9 per 1,000,000. How could the right hon. Gentleman say that the state of any part of London was satisfactory when figures like these could be adduced? In Glasgow there was not a Government establishment to do it with national funds. In London there was. What was made of it? In London the principle was good; but the working was bad. There was too much circumlocution, too much red tape. If the right hon. Gentleman would set his mind to it, and compel officials to do their work in a different manner, he would bring out different results. If he could not do that, let him send to Glasgow and enlist the services of Dr. Russell. It would, however, be necessary, if Dr. Russell were brought to London, that he should not be smothered in officialism, and swathed in red tape. That was the curse in London. If Dr. Russell were brought to London, given full powers, and adequately supported, he (Mr. Anderson) had no doubt they would soon have in London results as good, or nearly as good, as were now brought out in Glasgow. There ought not to be, notwithstanding the fact that London was eight times larger than Glasgow, so vast a discrepancy in the percentage of mortality from small-pox. He admitted that in a town eight times larger there might fairly enough be rather more than eight times the disease; but if, instead of 9 per 1,000,000, it were 10, or even 12, there might not be much to say; but when, instead of 9 or even 12, it was 226, and that for the very best part of London, the condition was seriously wrong. The fact was, the whole country had a right to complain of London as a pest centre, and there must be some fault in the Local Government Department. The right hon. Gentleman had not informed the House, nor had he traversed the fact, that some time ago London was in a doubly better position than Glasgow. From 1855 to 1864 the mortality per 1,000,000 in Glasgow was 570. In London it was only 232. In these figures they had disclosed a state of matters in which Glasgow was twice as bad as London; and in a few years, 1819 by simply changing the arrangement in Glasgow, and adopting a more rational system, and getting rid of rod tape and circumlocution, they got different results. Manchester and other large towns had done the same, and why not London? Their contention was, that it was the duty of the right hon. Gentleman to see that the London system was altered, so as to improve the present condition of things.
§ MR. HOPWOOD
considered it was unwise to create a panic among the people by raising such discussions, and giving vent to alarming statements. He hoped the Government would not be driven to the adoption of hasty and despotic action.
§ Notice taken, that 40 Members were not present; House counted, and 40 Members not being present,
§ House adjourned at Seven o'clock