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APPENDIX (A).

8. Circular of the Poor Law Board.

Poor Law BOARD,
WHITEHALL, S.W.,

20th February, 1869. Sir,

The Poor Law Board have received communications from the Lords of Her Majesty's Council, representing that unsatisfactory arrangements have been proposed to be made by the guardians of several unions, in reference to the attendances of the vaccinators at the different stations for the performance of vaccination. The Board, therefore, think it right to draw the attention of the guardians to the subject.

The Board are informed that it is of essential importance to the success and efficacy of the operation that vaccination should, as far as possible, be performed from arm to arm of the children, instead of by the means of preserved lymph. Under ordinary circumstances, the arm of a child on which the operation has been performed is, at the end of a week, in a state in which the lymph can be taken from it to vaccinate another child; and the Board further learn that the lymph used in vaccination should be carefully selected from the best formed vesicles upon the healthiest children. - The best vaccination is, therefore, to be obtained when attendances are given at weekly intervals, and when the children brought to be vaccinated are met by a sufficient number of other children, vaccinated the week before, from whom some can be selected to furnish lymph.

In proceeding to make arrangements for these weekly attendances, it is essential for the guardians to consider whether the circumstances of the district to which a station is assigned are such as to permit of vaccination being performed there in every week of the year, or only in certain series of weeks. This generally is a question as to the number of children who may be brought for vaccination, which again is principally a question depending upon the amount of population. It is only in very populous districts that efficient vaccination can be maintained at weekly intervals throughout the whole year. The regulations of Her Majesty's Council provide that

no town shall be divided into districts for vaccination, unless each district contain a population of at least 25,000 persons; that there shall be only one station in each town district; and that vaccination shall not be performed oftener than once a week; and in towns sufficiently populous their Lordships think it desirable that a population of 40,000 or 50,000, or even more, should be assigned to each station. Stations which are appointed for such populations as these can doubtless maintain continuous weekly vaccination throughout the year.

But in the less populous districts of the country, the object of procuring arm to arm vaccination with due selection of lymph cannot be obtained, if weekly attendances throughout the whole year are appointed. The limit of population at which it becomes expedient to restrict attendances for vaccination to certain periods of the year will vary in different cases according to various circumstances; such as the amount of private vaccination performed in the district, and the frequency with which the district is exposed to chances of small-pox infection. But at all events it may be said that, when the district which can supply cases to any station has a smaller population than 10,000 persons, the guardians ought to consider whether the number of applicants for vaccination at that station will be such that weekly vaccination throughout the whole year ought to be attempted. In proportion as the population attached to a station falls below 10,000, so it will be found more and more probable that vaccination cannot be satisfactorily performed there at weekly intervals throughout the whole year.

When vaccination cannot be performed at weekly intervals throughout the year, it is recommended by the Lords of Her Majesty's Council that the attendances for vaccination should be given either quarterly (in January, April, July and October), or half-yearly in April and October), for so many successive weeks as the circumstances of the district may seem to require. Section 12 of the Vaccination Act of 1867 permits guardians, with the consent of the Poor Law Board, to fix attendances in places with a scanty population at longer intervals than three months; and the Board will always be ready to consider any proposal submitted by the guardians to give effect, when required, to the provisions of this section.

The Board are also of opinion that, in districts in which there is more than one station, it may be desirable to arrange that so far as practicable the attendances at the several stations, instead of being appointed for different days in the same week, should be appointed for the same day in successive weeks, but at different hours, as for instance

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1st

FOR VACCINATION.

FOR INSPECTION. At station A Ist Monday 2nd Monday 2nd in

3rd in 3rd April 4th April. At station B 2nd Monday 3rd Monday 3rd in

4th

in April. 4th April

1st Do. in May. At station C 3rd Monday 4th Monday in April.

4th
in April

Do. May.
1st

2nd Do. May. By this means the vaccinator might take the lymph fresh from the arms of the children inspected at station A to vaccinate the children at station B, and so on.

The Board are not unaware of the difficulty which there may sometimes be on the part of parents in bringing their children to be vaccinated when the days for vaccination are few in the course of the year. To obviate this, as far as possible, care should be taken that, in addition to the printed notice, which the registrar of births and deaths is required by the 30 & 31 Vict. cap. 86, sec. 15, give to every person registering a birth printed notices of the times and places at which the vaccinator will attend should be kept continually exposed at the places in each parish where parish notices are affixed.

The Board request that these observations may receive the consideration of the guardians, and that they will endeavour to make such arrangements for the union as may, at the same time that they promote the practice of vaccination and secure its performance in the most efficient manner, be also most convenient to the medical practitioner contracting for its performance.

The Board desire to add that persons living within two miles of a station cannot, under the regulations of Her Majesty's Council, be vaccinated by the public vaccinator elsewhere than at a station, "unless for some special reason (to be noted in the vaccinator's register,) “ the person whom the vaccinator proposes to vaccinate cannot properly be vaccinated at the station," but that persons residing at a greater distance than two miles from the station may, when circumstances require it, be vaccinated at their own homes.

In conclusion, the Board request that the guardians, before they proceed to enter into any new contracts for vaccination, will communicate with the Board as to any alterations which they may propose to make in the existing arrangements.

l'he Board will, on receipt of such information, transmit to the guardians a form in which the arrangements may be clearly set forth for the final decision of the Board before the contracts are executed.

I am, Sir, your obedient servant,

H. FLEMING, Secretary,

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3 & 4 Vict. c. 29.1

An Act to extend the Practice of Vaccination.

Poor Law Guardians to contract with their medical officers, or

[23rd July, 1840. I. Whereas it is expedient to extend the practice of Vaccination :: Be it therefore enacted, that from and after the passing of this Act it shall be lawful for the guar

dians of every parish or union, and for the overseers of other medi- every parish in which relief to the poor shall not be cal practi- administered by guardians, in England and Wales, and vaccination. they are hereby directed to contract* with the medical

officers of their several unions or parishes respectively, or with any legally qualified medical practitioner or practitioners, for the vaccination of all persons resident in such unions or parishes respectively : provided always, that it shall be a condition of every such contract that the

tioners for

I With regard to the repeal of this Act, see 30 & 31 Vict. c. 84, s. 1, ante, p. 25.

2 In a case which occurred in 1835, it was held that an overseer was not bound to take measures to cause the paupers of the parish to be vaccinated during the prevalence of the smallpox. In that case, the small-pox having broken out in the parish, an agreement was entered into with a medical man to vaccinate the paupers at ls. 6d. per head. One of the overseers, a party to this agreement, subsequently refused to allow it to be carried into effect; and all the paupers in the parish afterwards caught the small-pox, and one of them died; but it did not appear that any of the paupers had either applied, or consented, to be vaccinated. The Court refused to grant a criminal information against the overseers; considering that it was no part of the duty imposed by law on overseers, to cause paupers to be vaccinated. Anon. 3 A. & E. 552; 5 N. & M. 12; 4 L. J. (n. s.) M. C. 112; 1 Lum. P. L. C. 41.

3 As to the meaning of the word “union," see the interpretation clause, s. 9, post.

4 See 16 & 17 Vict. c. 100, post; 21 & 22 Vict. c. 97, post, and 22 & 23 Vict. c. 3, post.

5 See 21 & 22 Vict. c. 97, s. 2, post; and the regulations of the Privy Council, Appendix (A), ante, p. 88. See also “the Medical Act,” 21 & 22 Vict. c. 90.

6 It was considered that these terms required that each contractor for vaccination in a union should contract to vaccinate

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