Guardians to divide

unions and

vaccination

districts,

or to con

solidate or alter them, subject to approval of the Poor

Law Board.

be in any respect inconsistent with the provisions herein contained.1

II. The guardians of every union or parish where the same shall not have been divided into districts parishes into for the purpose of Vaccination shall, unless such union or parish respectively shall be of so limited an area as not to require subdivision, in which case the same shall be treated as a Vaccination district within the meaning hereof, forthwith divide the union or parish for which they act into districts for the performance of Vaccination; and when the Poor Law Board shall by their order require any1 districts for the time being to be consolidated or otherwise altered, the guardians shall proceed to consolidate or alter the same, and they shall in every such case of division, consolidation, or alteration, report their proposal to the Poor Law Board for their approval, which Board shall approve or disapprove of the same as they see fit; and the guardians of every3 union or parish may, with like approval, from time to time as they shall find it requisite, alter the districts heretofore3 formed or hereafter to be formed for the purpose of Vaccination.

See Introduction, ante, pp. 20, 21. The existing districts and contracts will continue in force, and will be governed by the statutes under which they were made, taken in connexion with the present Act; but the districts may be altered or modified under the provisions of ss. 2 and 3, post, and the contracts may be put an end to in any case, either by the guardians or by the vaccinator himself, under the last clause of the agreement.

2 In his "Handbook of Vaccination, 1868," Dr. Seaton observes (p. 99):-"The terms 'vaccination' and 'to vaccinate,' to signify the inoculation of the cow-pox, were first introduced by Dunning-[Baron's Life of Jenner, vol. ii, p. 336]; and their convenience was at once recognised. They are the terms now exclusively employed for the purpose in medical writings, in the conversation of the educated, and among the common people also in the greater part of England; but there are still parts of the kingdom in which the lower orders seem never to have heard of vaccination, though they are quite familiar with the process of being 'cut for the cow-pock.""

3 The second clause of s. 2 is general, and is not confined to the districts to be formed under the first clause. As to notice of alterations, see s. 13, post.

Board do

scheme to

proved,

contract for

III. If the said Board disapprove of the proposal If the the guardians shall forthwith proceed to prepare not approve, another, and submit the same to the said Board for another approval, and so on from time to time as shall be be prepared; requisite until their proposal shall be approved, and when apwhen the said Board shall have approved of the same guardians to the guardians shall enter into a contract with some performance duly registered medical practitioner for the perform- of vaccinaance of Vaccination of all persons resident within each district; and every such medical practitioner shall be termed the public vaccinator of the district; and as and when the contracts now existing shall determine the guardians shall enter into others, with such modifications as the circumstances shall render necessary, subject to the like approval of the Poor Law Board as aforesaid.4

tion.

nator to be

by Lords of

Council, and

by them.

IV. No person shall be appointed a public vac- Qualification cinator, or act as deputy for a public vaccinator, who of vaccishall not possess the qualification heretofores pre- prescribed scribed by the Lords of Her Majesty's Council, or the Privy such as shall be from time to time hereafter pre- other regu scribed by them, except when such Lords shall upon lations to be sufficient cause sanction any departure from their prescribed directions; and all such regulations as the said Lords have heretofore5 made or shall hereafter make, which they are hereby authorized to make, to secure the efficient performance of Vaccination or the provision and supply of vaccine lymph by the public vaccinator, and all such directions or regulations as the said Lords acting under any Act for the prevention of diseases may issue in relation to small pox, shall be duly observed by the several persons to whom they apply; and the said Lords may from time to time cause such inquiries to be made relating to the observance of such regulations and to the execution of this Act as to them shall seem fit, and shall direct how any money hereafter to be provided by Parliament for or towards defraying the expenses of the

4 See ss. 1 and 2, and the notes thereon, ante.

• See Appendix A, post, p. 88.

6 See s. 17, post.

As to allowances

National Vaccine Establishment, or otherwise providing for the supply of vaccine lymph,1 shall be applied.

V. On reports made to the Lords of Her Majesty's Council with regard to the number and quality of the vaccinators. vaccinations performed in the several vaccination

to public

As to fees payable for

districts of England,3 or any of them, the said Lords may from time to time, out of monies provided by Parliament, and under regulations to be approved by the Lords Commissioners of Her Majesty's Treasury, authorize to be paid to any public vaccinators, in addition to the payments received by them from guardians or overseers, further payments not exceeding in any case the rate of one shilling for each child whom the vaccinator has successfully vaccinated during the time to which the award of the said Lords of the Council relates.

4

VI. Every such contract for Vaccination shall5 vaccination. provide for payment in respect only of the successful vaccination of persons, and so that the rate of payment for primary vaccinations shall be not less than the following; that is to say, for every such vaccination

1 See s. 17, post.

2 This clause is substituted for s. 2 of 21 & 22 Vict. c. 27, which is repealed by s. 1 of the present Act. See also s. 3 of the former Act; Appendix B, post, p. 122.

3 Including Wales. See notes (1) and (2), ante, p. 25.

4 In some places contracts might be entered into by overseers before 1st January 1868, and these may continue in force (see s. 1, ante); but overseers will not be empowered to enter into any further contracts. See Introduction, ante, p. 21.

The scale of remuneration here prescribed is much more favorable to the vaccinator, than the one laid down in the former Act 16 & 17 Vict. c. 100. s. 6. See Appendix B, post, p. 111. The new scale will only apply to contracts which may be entered into after the 1st January 1868, although the provisions of s. 8, post, with regard to the payment for re-vaccinations, will take effect upon contracts entered into before that date. The vaccinator therefore cannot be paid under the new scale so long as the old contract remains in force; but that contract may be put an end to at any time by either party (see note to s. 1, ante, p 26); and a new contract entered into under the present Act, with the approval of the Poor Law Board. 6 As to re-vaccinations, see s. 8, post.

done at an appointed station situated at or within one mile from the residence of the vaccinator, or in the workhouse of the union or parish, not less than one shilling and sixpence; and for every such vaccination done at any station over one mile and under two miles distant from his residence, not less than two shillings; and for every such vaccination done at any station over two miles distant from his residence, not less than three shillings; such distance

7 The word "residence" must no doubt be understood here in its ordinary sense, as referring to the usual home, abode or dwelling of the vaccinator; and consequently will not include a surgery or other place, at which he merely attends, daily or otherwise, for the sole purpose of exercising his profession.

With respect to the vaccination of paupers who are inmates of a workhouse, it is provided by the General Consolidated Order of the Poor Law Commissioners, Art. 207, No. 5, that it shall be the duty of the medical officer for the workhouse to vaccinate such of the children therein as may require vaccination (see Glen's Poor Law Board Orders, sixth edition, 1868). It was formerly considered that such vaccination ought not to be included in the contracts with the public vaccinators, as it formed part of the duty of the workhouse medical officer, to be remunerated by his salary or otherwise ("Official Circular," March 1848, vol. 7, p. 203); but it is now provided, by s. 6 of the present Act, that a specific fee of not less than eighteen pence shall hereafter be paid under contract for every case of primary vaccination in a workhouse. The section directs that this payment shall be provided for "in every such contract for vaccination," i.e. the contract with each public vaccinator; but it is manifest that this direction cannot be taken literally, as it would give all the public vaccinators in a union the right or duty of vaccinating the inmates of the workhouse. The Poor Law Board have construed the enactment, according to its apparent intention, as applying to the medical officer of the workhouse, and have recommended that the payment of the fee referred to should be provided for in the contract which he enters into with the guardians as their medical officer, and not in a separate contract for vaccination. This is not perhaps a strict compliance with the letter of the clause, but it is in conformity with its spirit, and sufficiently accomplishes its object. No such fee, however, will be legally payable except under a contract.

The Poor Law Commissioners expressed the opinion, that the guardians have the right, without the permission of the parents, to vaccinate any child in their custody, during any danger of contagion from the small-pox. For this opinion, and the considerations on which it is founded, see their "Official

Conditions

posed in the

contracts to secure due vaccination of persons.

being measured according to the nearest public carriage road; but in respect of successful vaccinations performed elsewhere than at a station or in the workhouse, as aforesaid, the payment shall be according to the terms specified in the contract as approved of by the Poor Law Board.

1

VII. The guardians shall, with the consent of the may be im Poor Law Board, make stipulations and conditions in their contracts3 to secure the due vaccination of persons, the observance of the provisions of this Act with regard to the transmission of the certificate of successful vaccination, and the fulfilment of all other provisions of this Act on the part of the public vaccinator, and shall provide all stations at which the vaccination shall be appointed to be performed other

Circular," July 2, 1840, vol. 1, p. 72. The Poor Law Board have expressed the further opinion that, if the guardians and the workhouse medical officer think that any child in the workhouse requires vaccination, the medical officer should vaccinate such child, in accordance with the article above adverted to, (Art. 207, No. 5,) notwithstanding any objection on the part of the parents, ("Official Circular," March 1848, vol. 7, p. 204). The article referred to is confined to children, and does not extend to the adult inmates of the workhouse; but such inmates, though they cannot be compelled to undergo the operation, may desire it to be performed.

It is not the duty of the medical officer of the workhouse, as such, to vaccinate the officers and servants of the establishment. As to the admission into the workhouse of paupers suffering from small pox, and the importance of providing separate infectious wards for the reception of such cases, see 66 Official Circular," January 1, 1846, vol. 6, p. 15.

1 See note (8) s. 6, p. 29.

2 See note (5) s. 6, p. 28. The Act imposes no restriction as to the fee for vaccination elsewhere than at a station, except by making it subject to the approval of the Poor Law Board. It need not necessarily be of the same amount for all cases, but may vary according to distance, if the Poor Law Board approve. With regard, however, to the practice of vaccinating elsewhere than at a station, see the Regulations of the Privy Council, Appendix A, post, p. 85.

3 See the Form of Contract prescribed by the order of the Poor Law Board, Appendix A, post, p. 77.

The expense of providing stations in unions is chargeable to the common fund, under the provisions of the Union Chargeability Act, 28 & 29 Vict. c. 79, s. 1; Appendix B, post, p. 127.