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lodging-houses to submit to vaccination. The Council exhibited a notice in all common lodginghouses advising the inmates to seek this means of protection against smallpox, and the Council's officers exercised such influence as they had over the lodgers, but the only inducement which was successful on a large scale was the course adopted in a few instances by the sanitary authority, viz. the offer of a small sum of money which would enable the lodger to live for a few days without work if the effect of the vaccination was such as to prevent him from following his employment."

CHAPTER VIII

VACCINATION

THERE are various points regarding vaccination which require to be mentioned.

First, as to the efficacy of recent and successful vaccination, a matter upon which I have known doubt expressed even by medical practitioners themselves. Any one who is recently and successfully vaccinated cannot, by any loss of health, by any degree of exposure, or by any possibility of any kind at all, contract smallpox. There is not the slightest risk. If it were possible to conceive of a recently and successfully vaccinated millionaire, who wanted to have experience of the disease in his own body, all his millions could not possibly gratify his wish.

If a word of advice may be suggested to a young Medical Officer of Health, it would be this, to be drawn into no dispute or discussion

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the "vaccination question." An inquirer is entitled to his opinion, and you are entitled to yours. Let it rest at that. It may be different when your opinion and your reasons therefor are required by the Authority who retains your professional services. Then of course your advice should be fully given and stated with due firmness. Yours is the advice; the responsibility of the ultimate decision rests with the Authority who employs and consults you.

In the matter of giving reasons to those whose right or wish is to be informed, I have found two items from my own experience to carry weight; they may be worth mentioning here. They have the advantage, which is no slight one in discussing vaccination, of being observations in the actual field. The first is this.

It is the practice at the London Smallpox Hospitals, when a patient is dangerously ill, to inform the near relatives that their visiting would be allowed in the special circumstances. Such visitors are warned of the risk which they run of contracting the disease, are instructed to take suitable precautions, and are offered vaccination for their own protection. Not a few refuse

the offer, and proceed in charge of a nurse to visit their sick friends. It has not infrequently happened that such visitors have returned to the hospital about a fortnight later, themselves suffering from smallpox. But the nurses who have accompanied them, and were equally exposed, have escaped. There has thus been carried on, as it were, a series of experiments, in each case of which two persons have been exposed to infection. On some occasions both nurse and visitor have escaped. On other occasions the visitor has sickened and the nurse has escaped. It has never happened that the visitor has escaped and the nurse has sickened, or that both have sickened. An independent inquirer would be struck by such a series of phenomena and would cast about for an explanation. He would find that the only factor common to all the occurrences was that the nurses were recently and successfully vaccinated, and that the visitors were not so conditioned.

The second item is this. During the 1901-1902 epidemic, when about 10,000 patients passed through my hands at the London Receiving Station, I saw a considerable number of mothers who themselves had smallpox, and had infants at

the breast who were entirely free from the disease. The mother, when apart from the infant, had been exposed to infection and taken it, and had gone on nursing her infant until the rash of smallpox came out. Although these infants were then exposed to infection with extreme thoroughness, and it would seem inevitable for them to take smallpox, in point of fact a number of them never took it. Those who did not take it, differed from those who did, in having been successfully vaccinated within three days of exposure to infection.

Questions may often arise about the necessity of renewing and bringing vaccination up to date. The fact is that protection conferred by vaccination wears out after a lapse of time which is uncertain and varies with each individual. No one can say, for any given individual, what the length of that lapse of time may be. Revaccination may be effective for a period of 20 years. Primary vaccination does not confer immunity for so long a period as this.

To a person who is in doubt, or who is unwilling to be re-vaccinated, the risk may be clearly stated, and the matter, so far as the operation is concerned, may be fairly put in this way. If

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