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1795 for the necessity of going before a magistrate for the purpose of getting exemption. What were the exemptions in the following years ? They went up to 162,800 in 1908 and to 190.0CO in 1909; that was to say, they went up from a percentage of 4 6 in 1905 to 20’8 in 1909. That happened in two years after the passing of the Act. If exemptions proceeded in the future with anything like the rapidity which they had recently done, vaccination would be in a dangerous position in this country. Everyone must see that the position was one of a grave and serious character. When hon. Members were confronted with results like these in so very short a time after the passing of an Act to amend the Act of 1898, he thought that the right honourable gentleman would allow that he (Mr. Chaplin) was, at all events, justified in taking this early opportunity of pointing to some of the conse- quences which had followed. He hoped that the President of the Local Government Board would take ;nt,o his most serious consideration the question whether steps ought not to be taken to discourage this enormous increase in the exemptions from vaccination, which, if they continued at their present rate, must constitute a great danger to the country. .mr. j3uRNS (tne l:"’reS1Oent or tne iocai liovernmenr .lIoaro) saia, m reply, that he would deal with the complaint of the vaccination officers before coming to the question of vaccination itself. There were 1420 vaccination officers in England and Wales and they were all paid by fees. 400 gave their whole time to the work and 1020 held other appointments, such as relieving officers or registrars of births, marriages, and deaths. Honourable Membets should bear that in mind when considering the question of their total remuneration. The fees paid to them were paid and fixed by consent of the Local Government Board. Some people talked about the minimum fee of 3d. being adhered to and thought that 9d. was paid for every successful vaccination alone. In many cases where the population was dense the guardians thought that the minimum fees of 3d. and 9d. respectively yielded sufficient remuneration. Where the population was not so dense the 3d. fee became 6d., and the 9d. in the case of successful vaccination became a fee of ls. 6d. or 2s. 3d. and the average remuneration of these gentlemen for this work was very often from E150 to z6200 and in some cases £300. He found that since the Act of 1907 was passed, tthen he only carried one step further the principle of helping the conscientious objector, the exemptions had increased from 57,675, or 6 2 per cent., to 190,000, or 20 8 per cent. The exemptions had in some cases caused a diminu- tion of income to some of the officers. He found that out of the 1420 vaccination officers, it was alleged that 487 had sustained a loss; but out of that number 217, or nearly a half, had been paid by their boards of guardians a gratuity to make good the loss, and this had been done with the consent of the Local Government Board. In the remaining cases vaccination officers had not always seen their way to apply for compensation, which was not his fault, or else the guardians had declined to pay gratuities. These two classes had to be met. Various suggestions had been made to meet these cases, but a number of them he could not consider. However, he was prepared to receive both from the vaccination officers and from the guardians a statement of their grievances as applied to each individual case where a reduction had been sustained, and he was prepared to meet them as fairly as in the interests of the public he had a right to meet them. That, he thought, was sympathetic and fair. The right honourable gentleman had suggested that the increase in the number of exemptions was a retrograde step and one from which he feared serious consequences. That, of course, was a matter of opinion, and upon it the House was rather sharply divided. So far as he could gather, although the exemptions had increased from 6 to 20 per cent. between 1907 and 1909, he was glad to inform the House that taking London, he saw from the report of the Local Government Board that in 1908, a year after the passing of the Act when the exemptions were rapidly increasing, there was not a single case of small-pox admitted in the small-pox hospitals of the Metropolitan Asylums Board. Dr. HILLIER : A very happy coincidence. Mr. BURNS : And the happy coincidence has continued since 1909. He did not share the alarming fears and suggestions of some people that one of the results of the exemptions under the Act of 1907 would be a serious increase of small-pox cases, and there was no reason to assume that the Act would have that effect. He thought that both the vaccinator and the anti-vaccinator had not sufficiently given credit to the effect on the education of the individual and of the improvement in domestic and public sanitation. He was positively convinced, taking a view of the whole situation, that neither the views of the one nor the hopes of the other had been justified by the last two years. It was with peculiar pleasure that he was able to say that there were no immediate signs or even prospects of the alarms and fears of the honourable I Members with regard to vaccination being proved by facts and results. MONDAY, JUNE 20TH. Certifying Surgeons. Mr. WEDGWOOD asked the Secretary of State for the Home Depart- ment whether he contemplated taking any steps to prevent the official certifying surgeons acting privately for trade unions or insurance companies in any capacity wherein fees were paid for medical decisions or reports.-Mr. CHURCHILL answered : It would not be pos,ible to lay down any general rule on the subject, because in industrial distric s it is often difficult to find a well-qualified medical man who does not hold s< me appointment in connexion with employers or associations of workpeople. The consideration, however, is borne in mind in making appointments, and the department is always prepared to inquire into any case of grievance that may be brought to its notice. I may add that an appeal lies from decisions of a certifying surgeon under the Workmen’s Compensation Act to the medical referee appointed under that Act. Infectioxss Hospitals Major ADAM asked the President of the Local Government Board whether he could state the number of infectious hospitals provided by the various local sanitary authorities in England and Wales, their cost for erection and maintenance, and the number of patients admitted over a convenient period of years ; and whether, in view of the diversity of the skilled and medical experience which existed on the subject and the cost to the ratepayers which was involved, he would cause an inquiry to be made into the whole question of the usefulness of infectious hospitals, other than small-pox hospitals, as a means of pre- venting the spread of disease, and generally, in view of the extended experience which now existed on the subiect, into the advantages or disadvantages which might be found to attend their use -Mr. BURNS replied : I am not at present in possession of complete information on the points mentioned in the first part of the question. I may say, however, that by the general order which will very shortly he issued in pursuance of Subsection 2 of Section 68 of the Housing, Town Planning, &c., Act of last session the county medical officer of health will be required to inquire into, and report upon, the hospital accommodation in each county and upon any need for the provision of further accommodation. As regards the second part of the question I am advised that there can be no doubt as to the utility of isolation hos- pitals in the prevention of the spread of infectious diseases when con- joined with good administration in regard to the other means necessary to prevent the spread of infection. among which the careful search for overlooked or non-notified cases of the same disease bears an important part. part. TUESDAY, JUNE 21ST. Postmen and Infection. Captain FABER asked the Postmaster-General what precautions, if any, were taken concerning postmen going on duty who had members of their families ill from contagious disease.-Mr. H. SAMUEL replied: In the case of certain specified diseases a postman is placed off duty immediately, and is not allowed to resume until instructions have been received from the chief medical officer to the Post Office. In the case of other diseases the postman remains on duty, but the case is at once reported to the chief medical officer, who advises whether it is neces- sary that the employee concerned should absent himself. Absence from duty on full pay is insisted on if there is considered to be any risk of conveying the infection, whether to the local post-office staff or to the public generally. The Censzts and the Birth-rate. , During the consideration of the Census Bill in Committee, ’ Mr. RAWLINSON moved an amendment to omit from the census forms the inquiry as to the number of children born of the marriage. He feared that the inquiry would be regarded as inquisitorial. *"" Mr. BURNS, in resisting the amendment, said that he did not’see how the inquiry could be regarded as inquisitorial. It was only confined to the number of children of an existing marriage. Toe reason why this question was being included was that nearly all the countries of the world were confronted with a very remark- able diminution of the birth-rate. The marriage-rate was stationary or showed only a slight diminution. To medical men and others interested in the matter of the birth-rate the information to be derived from such an inquiry was valuable as showing the fertility of marriages. He was told ot one professional occupation in which married women were employed almost as extensively as married men, where it was ascertained by a local authority that although the families from which the woman and her husband spring numbered on an average five or six, the average number of their own family was only one. That threw an interesting sidelight upon the employment of women. Such information as the census might afford in this respect might also throw light on infant mortality and on the subject of feeble-minded children. The amendment was rejected by 151 votes to 61. WEDNESDAY, JUNE 22ND. The Medical Inspection of Schools. Mr. CHARLES BATHURST asked the President of the Board of Education whether the Board had now received reports from every county in England and Wales showing the results for a complete year of the medical inspection of the children in the elementary schools; whether such reports disclosed the fact that over 40 per cent. of such children were suffering from some physical defect and that over 20 per cent. required, and should receive, some medical treatment; and whether, both in the interests of the national physique and to avoid the serious waste of public money consequent upon the attempt to educate children who were more or less physically incapable of receiving education, the Board proposed to take any, and, if so, what, steps to remedy the condition disclosed by the above reports.-Mr. RUNCIMAN said in reply: With reference to the first part of the question, the Board has received reports for the year 1909 from about two-thirds of the local education authorities con- cerned. It is not possible to state the fact s revealed by the report s which have been received in the form suggested in the second part of the question. The report of the chief medical inspector based upon the reports received from the local education authorities will be prepared in due course, and will deal fully with the conclustons which can be reasonably drawn from the results of the medical inspection in the year in question. As regards the third part of the question, the honourable Member is no doubt aware that the local education authorities have the power, with the approval of the Board of Educa- tion, under Section 13 (1) (b) of the Education (Administrative) Pro- visions Act, 1907, to make arrangements for attending to the health and physical condition of children educated in public elementary schools. This power is being exercised in various ways by many authorities. Appointments. Successful applicants for Vacancies, Secretaries of Public Institutions, and others possessing information suitable for this column, are invited to forward to THE LANCET Office, directed to the Sub- Editor, not later than 9 o’clock on the Thursday morning of each week, such information for gratuitous publication. EYRES, W. J., M.D.Aberd., has been appointed Interim Visiting Medical Officer of the Oldmill Poorhouse, Aberdeen. COLLINS, J. RUPERT, M.D.Dub., has been appointed Honorary Phy- sician to the Cheltenham General Hospital. DILLON, T. F., M.B., B.S. R.U.I., has been appointed Hospital Surgeon and Principal Medical Officer by the Committee of the Ebbw Vale Works.
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