¹ Sir Simon, John, English Sanitary Institutions (London, 2nd ed., 1897), 286.Google Scholar

² No standard text-books on general history seem to mention the vaccination system. More surprising is its omission from S. and Webb, B., English Poor Law History, Part 2, vol. 9 of English Local Government (London, 1906–1929).Google Scholar

³ Lancet, 1876 (a), 158.

⁴ Hansard, , 10 03 1840Google Scholar, LII, col. III0, Lansdowne. For the early history of the system see: Seaton, E. C., A Handbook of Vaccination (London, 1868)Google Scholar; Seaton, E. C. in Transactions of the National Association for the Promotion of Social Science (1857), 460Google Scholar ff.; Simon's Papers, infra; Hutchinson, J. R., ‘A Historical Note on the Prevention of Smallpox’, Report of the Ministry of Health for the year ended 31 March 1946 (P.P. 1946–1947), XII, 125 ff.Google Scholar; and polemical works—White, W., The Story of a Great Delusion (London, 1885)Google Scholar, and Swan, J. P., The Vaccination Problem (London, 1936).Google Scholar

⁵ Hansard, , 17 06 1840Google Scholar, LIV, col. 1244, Graham. The opposition to lay control was led by Wakley, editor of the Lancet.

⁶ (P.P. 1852–3), ci, 75 ff. The Committee's Report was dated 26 March 1853 and over 2OOO medical practitioners were consulted in its compilation. The Society was formed on 30 July 1850 with John Simon among its founders: see its Commemoration Volume (London, 1900), 4–6.

⁷ Copy of a letter… by John Gibbs (P.P. 1856), LII, 489. The Act to Extend and Make Compulsory the Practice of Vaccination, 16 & 17 Vict., cap. 100. The alterations did not satisfy the Society (Seaton, Handbook, 350) or the Lancet, which predicted ‘that it will probably be inefficient’ (Lancet, 1853 (2), 251, 531, etc.).

⁸ The ratios of all public vaccinations to births 1853–9 varied: 62·6 per cent, 112·1 percent, 74·S Per cent, 67·9 per cent, 65·1 per cent, 71·5 per cent, 68·0 per cent. These overall ratios include vaccinations of children over one year of age, unsuccessful and secondary vaccinations. A better index to the extent of public provision would be the annual percentage ratios of children publicly vaccinated within the year of their birth. There are no such ratios for the 1850'8, but we do know that in the decade before 1853 they averaged 31·8 per cent p.a. Private vaccinations accounted for about 10–15 per cent of children born in one year (Memorial of the Epidemiological Society (P.P. 1854–1855), XLV. 630). Overall ratios quoted here and later from 23rd Report of the Poor Lav; Board (P.P. 1871), xxvn, 478.

⁹ Memorial, 633. The Poor Law Board did its best but without great conviction; Hansard, 18 July 1854, cxxxv, col. 370, Saines; Seaton, , S.S.A. paper, loc. cit. supra. Lancet, 1858 (i), 440–1, 461–2.Google Scholar

¹⁰ SirSimon, John, 1816–1904Google Scholar; Medical Officer to the City, 1848–55.

¹¹ Hansard, , i 07 1857, CXL.VI, col. 722Google Scholar, Duncombe. The opposition was partly anticentralist and partly the reflexion of an anti-vaccination movement now stirring, of which Gibbs's Letter (supra) was the manifesto.

¹² Simon, , Sanitary Institutions, 264Google Scholar. The Papers (P.P. 1857 (2)), xxxv, 139ff.

¹³ Hansard, , II 04 1866, CLXXXii, col. 1096Google Scholar, Bruce. Simon described the effective systems of compulsion used on the continent. As late as 1889, he claimed that the Papers needed little alteration: 1st Report of the Royal Commission on Vaccination (P.P. 1889), xxxix, Q. 118.

¹⁴ Papers, p. 227. Simon drew largely on Seaton and the Society for all his vaccination work.

¹⁵ Hansard, , 19 07 1859, CLV, col. 14Google Scholar. The Act for vesting in the Privy Council certain Powers for the Protection of the Public Health, 21 & 22 Vict., cap. 97, continued for only one year and became permanent in 1859, when Lowe jettisoned Clause 8.

¹⁶ Royal Sanitary Commission, Minutes of Evidence (P.P. 1868–1869), xxxii, Q. 1975.

¹⁷ Treasury Board Papers, T. I (1870), 22,046, 12 Feb., Helps to Treasury, enclosing Simon's memorandum of 27 July 1869. See also his statement in Martin, A. P., Life and Letters of Robert Lowe, Viscount Sherbrooke (2 vols., London, 1893), II, 189.Google Scholar

¹⁸ 1st Report of the Vaccination Commission, Q. 95.

¹⁹ 2nd Report of the Medical Officer to the Privy Council (henceforward given as R.M.O.P.C.) (P.P. 1860), xxix, 208.

²⁰ Simon always had intended that the state should provide some education to supplement that to be provided by the medical schools. Now, however, the state system had to be much larger and certificates could only be obtained through it.

²¹ 1st R.M.O.P.C. (P.P. 1859(1)), xii, 264. For the reorganization: ibid. 260–6; 2nd R.M.O.P.C. (P.P. 1860), xxix, 205–30.

²² Lancet, 1859 (i), 323; ibid. 296; (2), 622. Minutes of the General Council of Medical Education and Registration, I, 137, 320, 331; II, 260–1, 357.

²³ 2nd R.M.O.P.C. (P.P. 1860), xxix, 231.

²⁴ Hansard, , 10 07 1861, CLXIVGoogle Scholar, col. 675, Lowe.

²⁵ Privy Council Office Correspondence, P.C. 8/19, 17 June 1863, Simon to Helps.

²⁶ 3rd R.M.O.P.C. (P.P. 1861), xvi, 359. The four inspectors were Seaton, Stevens, Buchanan and Burdon Sanderson—all paid on a daily basis. Simon had continually to fight die Treasury to keep the investigation going: e.g. P.C. 8/31, 18 May 1863, Simon to Helps.

²⁷ 12th R.M.O.P.C. (P.P. 1870), xxxvin, 640.

²⁸ 5th R.M.O.P.C. (P.P. 1863), xxv, 56, Seaton. Seaton, , Handbook, 169ff. and 257ff.Google Scholar, summarizes the results of the inspections.

²⁹ 4th R.M.O.P.C. (P.P. 1862), xxii, 543, Stevens's Report. For corroboration of this response: 3rd R.M.O.P.C. (P.P. 1861), xvi, 388–9, Seaton; ibid. 366, Simon. Hansard, , 10 07 1861, CLXIV, col. 676Google Scholar, Lowe; and other Annual Reports.

³⁰ 12th R.M.O.P.C. loc. cit.

³¹ Poor Law Board Correspondence to Privy Council, M.H. 19/183, from 25 Jan. 1861, Helps to Poor Law Board, to 4 March 1862, Simon to Poor Law Board; also letters II, 17 Feb. 1863 and I Aug. 1867 between Council and Board. The text can only indicate the nature of this lengthy controversy.

³² Larger districts meant that children could be vaccinated by fresh lymph taken from the arms of recently vaccinated children attending the same station. This avoided the use of ineffective preserved lymph. For the controversy: M.H. 19/183, 14 Dec. 1861, Fleming to Privy Council et seq., including ‘one of the most extraordinary letters which one public Department could send to another’ (Lumley's minute on 30 Jan. 1862, Council to Poor Law Board). Public criticism: 4th R.M.O.P.C. (P.P. 1862), xxn, 470–4; 5th R.M.O.P.C. (P.P. 1863), xxv, 56, Seaton; 117, Buchanan.

³³ 2nd R.M.O.P.C. and to Local Government Board (P.P. 1875), XL, 8.

³⁴ 5th R.M.O.P.C. (P.P. 1863), xxv, 2–3.

³⁵ 7th R.M.O.P.C. (P.P. 1865), xxvi, 7.

³⁶ Treasury Outletters, T. 9/12, 9 Dec. 1864, Treasury to Council. Simon's original letter: P.C. 8/51, 14 Nov. 1864, Simon to Clerk. These appointments were turning points in the growth of the Medical Department.

³⁷ T. I (1866), 11,704, 23 June, 13 July, Council to Treasury. T. 9/12, 4 07 1866Google Scholar, Treasury agreement to Council.

³⁸ T. I (1866), 11,704, 7 March, Simon, to Bruce, H. A.. For Lowe's part: British Medical J. 1874 (i), p. 178.Google Scholar

³⁹ 9th R.M.O.P.C. (P.P. 1867), XXXVII, 8.

⁴⁰ 3O & 31 Vict., cap. 84, clause 4. Bruce, Simon's former chief as Vice-President, sponsored the Bill, openly mentioning the ‘erroneous advice’ and ignorance of the Poor Law Board (Hansard, , II 04 1866, CLXXXII, col. II00).Google Scholar

⁴¹ M.H. 19/183, 9 Oct. 1868, Seaton to Poor Law Board, minute by D. Fry. For the conflict: letters subsequent to 7 Dec. 1867, Council to Poor Law Board.

⁴² P.C. 8/164, 27 July 1869, memorandum to Lord President by J. Simon.

⁴³ Local Government Board Correspondence to Treasury, M.H. 19/209, 25 Nov 1874, minute signed Seaton and Simon.

⁴⁴ Report and Minutes of Evidence of the Select Committee on the Vaccination (Amendment) Act 1867 (P.P. 1871), XIII, Q. 3121; Q. 5425, Seaton. Seaton had his own children publicly vaccinated and Forster, Vice-President from 1868, also demonstrated his faith in the public system by anonymously undergoing revaccination at a public station: Reid, T. Wemyss, Life of the Rt. Hon. W. E. Forster (2 vols., London, 1888), II, 6.Google Scholar

⁴⁵ The number of children under one year publicly vaccinated, expressed as a percentage of births, varied in the years 1866–70: 45·9 per cent, 46·5 per cent, 50·4 per cent, 52·6 per cent, 50·4 per cent. In the decade 1861–70, an average of 49·46 per cent of children were publicly vaccinated within the year of their birth (1871 Committee, Q. 5352, Seaton). The gap between these figures and the overall ones in the text should be filled by revaccinations and vaccinations of children over one year. The overall percentages of public vaccinations to births 1861–70 were: 63·1 per cent, 63·0 per cent, 91·4 per cent (in the epidemic year 1863), 72·7 per cent, 79·2 per cent, 61·9 per cent, 64·8 per cent, 67·2 per cent, 68·0 per cent, 60·7 per cent.

⁴⁶ 12th R.M.O.P.C. (P.P. 1870), xxxviii, 626. Brighton, : Lancet, 1870 (2), 545Google Scholar. Remonstrances, : 13th R.M.O.P.C. (P.P. 1871), xxxi, 794.Google Scholar

⁴⁷ 1871 Committee, Q. 5375, Seaton, . Lancet, 1868 (2), 812–13Google Scholar, shows that Seaton secured the appointment of a vaccination officer and four assistants and a vigorous application of the Act at Sheffield. This was typical of many other such cases.

⁴⁸ 1871 Committee, Q. 5551.

⁴⁹ Royal Sanitary Commission, Q. 1975.

⁵⁰ In the 1837–40 epidemic the smallpox mortality had been 41,644; in the years 1870–3 it was 46,012, though the population had risen by a third to a half as much again. The mortality was much less than in countries without vaccination and lower than the average annual smallpox mortality in the pre-vaccination period. Vaccination had saved the country from something much worse. See Beaton's analysis in 2nd R.M.O.P.C. and Local Government Board (P.P. 1875), XL, 9, 51ff. Frazer, W. M., History of English Public Health (London, 1950), 169–70.Google Scholar

⁵¹ 34 & 35 Vict., cap. 98. Simon had urged the abolition of continuous penalties, but a clause to this effect was cut out in the Lords by one vote, and they remained on the statute book till 1898.

⁵² M.H. 19/184, memoranda by Lambert, , 19 09Google Scholar, and Stansfeld, , 26 09 1871.Google Scholar

⁵³ 6th Report of the Local Government Board (P.P. 1877), xxxvii, xxxix–xl. Local Government Chronicle (1876), 537–40, 760.

⁵⁴ 2nd R.M.O.P.C. and Local Government Board (P.P. 1875), XL, 8.

⁵⁵ Altogether between 1867 and 1874 the cost of public vaccination was £588,151 of which £43,428 was paid by Parliament. The average annual cost 1867–70 had been £63,754 (Local Government Chronicle (1876), 42).

⁵⁶ The average percentage of all successful primary vaccinations by public vaccinatore was 58–7 per cent of births between 1873–82; and the average successful primary vaccinations of children under one year was 55·9 per cent. Adding 3 per cent for secondary vaccinations of children under one year, we reach the 59 per cent approximation in the text. Thus in 1844–53 the state vaccinated only 31·8 per cent of children within a year of their birth; between 1861 and 1870 the percentage was 49·46; and between 1873 and 1882 was 59 per cent. Overall percentages of public vaccinations to births (including revaccinations and all other categories) were about 89 per cent and 85 per cent in 1871–2 and probably averaged about 65 per cent during the following decade, tending to fall as fewer of the population escaped vaccination at birth. There are no overall percentages given after 1872 (28th Report of the Local Government Board (P.P. 1899), xxxvii, 490).

⁵⁷ 2nd R.M.O.P.C. and Local Government Board (P.P. 1875), XL, 17. The percentages accounted for are taken from Seaton's annual analyses in these Reports and from 5th Report of the Royal Vaccination Commission (P.P. 1896), XLVII, 883. Between 1872 and 1883 the percentage of births unaccounted for varied from 4·3 to 5·1. Even at this peak, the system never matched the completeness of the Scottish one, set up in 1863 on strict Epidemiological Society principles; cf. the two sets of results (ibid. 928, 930).

⁵⁸ The Times, 4 Apr 1874.

⁵⁹ Lancet, 1876 (I), 576.

⁶⁰ E.g. Finer, S. E., The Life and Times of Sir Edwin Chadwick (London, 1952), 501 ffGoogle Scholar. For Chadwick the progress made in the years 1854–75 was doubtless ‘bitterly disappointing’. But an examination of the work of the central health departments in these years simply does not bear out Prof. Finer's assertions about the virtual disappearance of central inspection, and the ubiquity of local opposition to sanitary reform. In listing the undoubted retrogressive factors in the period, Prof. Finer omits all mention of such progressive features as the vaccination system, the creation of the Medical Department, the growth of central supervision, of state scientific research, of Poor Law nursing and the medical service, the great Sanitary Act of 1866, the Metropolitan Asylums Act, local developments, etc.—all of which characterized the 1860's. Likewise, Keith-Lucas, B. in his edition of Redlich and Hirst, The History of Local Government in England (London, 1958), I, 155Google Scholar, leaves unamended the statement that the Public Health question ‘slept’ in the 1860's—this, despite the above, despite parliamentary activity in the shape of six Sanitary Acts, two Nuisance Acts, two Local Government Acts, despite the much greater activity of administration, local authorities, voluntary bodies, etc. My forthcoming book, Sir John Simon and English Healtl Administration, will deal with the years 1855–75.

⁶¹ This does not deny the contribution of these influences: thus Arnott and Kay, in the course of the famous 1838 inquiry, called for extended vaccination, Chadwick constantly supported vaccination, and the Board of Health made some changes in the 1853 Act. But the driving force was always elsewhere.

⁶² Hansard, , 30 05 1864, CLXXV, col. 779Google Scholar, Granville; 13 June, col. 1641, Bruce.

⁶³ Clark, G. S. R. Kitson, ‘“Statesmen in Disguise”: Reflexions on the History of the Neutrality of the Civil Service’, Historical J. II, I (1959), 19–39Google Scholar. I owe Dr Kitson Clark thanks for much help in the last few years.

⁶⁴ T I (1871), 18,953, 19 May, Simon to Clerk, minute by Lingen of I June. The latter had to give way to a barrage of technical argument from Simon.

⁶⁵ MacDonagh, O. O. G. M., ‘The Nineteenth-century Revolution in Government: a Reappraisal’, Historical J. I, I (1958), 57Google Scholar. Dr MacDonagh has also given much kind advice for which I am grateful.

⁶⁶ Simon always regretted later the adoption of continuous penalties in 1867.

⁶⁷ Minutes of General Medical Council, v, 280ff.; vi, 5, 228–36; xiii, 306, 312–14.