S. B. H. No. I 12—1882. 
Vaccination of School Children. 
ILLINOIS STATE BOARD OF HEALTH. 
OFFICE OF THE SECRETARY, 
Springfield, September 20, 1882. 
To County Superintendents, School Boards and Teachers: 
Communications received since the beginning of the present school 
year, indicate the necessity for renewed instructions concerning the 
School Vaccination Order of the State Board of Health, promulgated 
in December, 1881. 
The Order has been complied with to a very gratifying extent. Its 
wisdom and utility have been demonstrated by the facts— 
First.—That among the thousands of cases of small-pox which have 
occurred in the State since the Order was issued, not one is reported of 
a public scholar who had been properly or recently vaccinated. Several 
cases, however, with a large proportion of deaths, have occurred among 
scholars who had either not been vaccinated at all or not since infancy. 
Second.—That in no instance where the Order was thoroughly enforced 
has it been necessary to close the public schools, even when small-pox 
existed in a community. On the other hand, schools have been 
broken up and studies interrupted in a number of instances where—as 
shown by the returns in this office—the Order had been neglected. 
In some of these latter cases the failure to enforce the Order was due 
to causes which no longer exist. The present is a very favorable season 
of the year in which to vaccinate. Good vaccine matter can be readily 
procured, and the operation is not now liable to be complicated by the 
results which obtain in cold and changeable weather. 
Concerning the statements sometimes met with—of serious results 
from vaccination, loss of arms and even death—the Secretary takes 
occasion to say that he has made it his personal duty to investigate 
every report of the kind which lias come to his knowledge. The net 
result of such investigations is that not one such report has been sub- 
stantiated. He has been wholly unable to find any evidence of a death 
caused by vaccination, in this State, or even of permanent injury or 
serious illness, due to the operation alone. He does know, however, 2 
of hundreds of deaths—aside from the suffering, the loss of sight and 
the disfigured faces among survivors—caused by the neglect of vac- 
cination. 
There have been probably 2,000,000 persons vaccinated in the State 
of Illinois during the past eighteen months, and precisely in the ratio 
of such vaccinations in any given community is the assurance of 
freedom from interruption of the public schools, and immunity from 
danger of outbreaks of small-pox during the coming winter. Where- 
ever a community includes any considerable number of unprotected 
persons there is, not merely a liability, but an almost absolute certainty 
of trouble during the approaching cold weather, since the infection 
will inevitably find its way inter the State again from other infected 
localities during the winter. Decent outbreaks in some of the river 
counties clearly foreshadow this result, and these outbreaks will be 
much more serious then than now, when doors and windows are kept 
open and free ventilation and atmospheric disinfection may be secured. 
The indications are that the winter of 1882-3 will be a severe one, and 
such winters are, on the one hand, unfavorable to vaccination, while 
on the other, their conditions favor the propagation and spread of 
small-pox contagion. 
An examination of the reports thus far received shows that more 
than two-thirds of the total school population of Illinois, were unpro- 
tected against small-pox on the 1st of December, 1881. 
Of the two million vaccinations within the past eighteen months, 
over thirteen hundred thousand have been performed since the first of 
January, 1882, as the result mainly of this Vaccination Order, and of 
similar measures instituted by the State and local Boards of Health. 
Until these measures were fairly under way there was a steady increase 
of the small-pox—but coincidently with their successful operation came 
the decline of the disease, until now it is practically at an end in 
Illinois.* 
* The recent outbreaks above alluded to do not conflict with this statement. That in 
Monroe county was caused by an infected mattress thrown into the Mississippi river, and 
which lodged on Staten Island, near Harrisonville. Somelunvaccinated persons came in 
contact with the mattress, and a number of cases ensued. Thence it was carried into Ran- 
dolph county, where it found a number of other hnvaccinated individuals near Prairie 
du Rocher, and caused an outbreak among them, with three deaths at date of last report, 
September 14th. In Alexander county, near Goose Island and Promised Land, some 19 
cases and 4 deaths have resulted from infection brought also from the river. All these 
cases were among unvaccinated persons. 
Prom present indications, the chief source of danger is along the Mississippi river, 
south of St. Louis. The Immigrant-Inspection Service of the National Board of Health 
has diminished the danger of importations from the east to the minimum.' Many of the 
Mississippi and Arkansas river-counties have, however, been severely visited, and the 
conditions of life among the negro population of that region are not such as to warrant 
the belief that the contagion will be readily “stamped out” among them. It is liable 
to be introduced into the State from this source at any time until the disease dies out 
there for the want of material. And wherever introduced, it will flndlits victims among 
the unprotected. 3 
It remains now to perfect and perpetuate the results thus far accom- 
plished, and to this end—so far as the public schools are concerned— 
the following instructions are issued with reference to the School Vac- 
cination Order: 
1. The Order is permanent and continuous. At the beginning of 
the school year teachers must satisfy themselves of the vaccinal status 
of each of their scholars. This will he done in the case of scholars who 
were in attendance during the last term, by an examination of the vac- 
cinal record required to be kept by the teachers, or by an examination 
of the scholar’ certificates. Scholars whose records are imperfect, as 
well as all new pupils, must present to the teacher (a) certificates of 
proper vaccinal protection; or (b) certificates that they are protected by 
previous attacks of small-pox or varioloid; or (c) that they are insus- 
ceptible to vaccination; or (cl) that their physical condition is such as 
to make it imprudent to vaccinate at the present time. 
Proper vaccinal protection means a successful vaccination in a child 
not yet arrived at the age of puberty; or, if beyond that age, a success- 
ful vaccination or re-vaccination, as the case may be, performed 
within the past two years (approximately.) 
The certificates above described must be signed in all cases by legally 
qualified physicians. 
2. Certificates must be returned to the scholars after the teacher 
has made the entries necessary to fill out the Vaccination Return (Form 
52) to the State Board of Health. The certificates must not be sent 
to this office. 
It is recommended that each teacher be provided with a book— 
Vaccination Record—in which to keep a permanent record of the vac- 
cinal history of the scholars. 
3. Vaccination Returns (Form 52) accounting for every child whose 
name appears on the School Schedule, must be forwarded to this office 
at the end of the second month of the school year.* The name of the 
child only need be given on this Return—provided all the data concern- 
ing it have been given on a previous Return. In such cases the words 
Previously reported should follow the child’s name. If the child’s record 
was imperfect on the previous Return, all the data now on hand should 
be given, as well as all data pertaining to new pupils. 
Supplemental Returns must be made at the end of each'term, embra- 
cing all new pupils and the perfected records of those previously 
returned imperfectly. ' 
4. Copies of Vaccination Certificates (Form 51) and of the Vaccina- 
tion Returns (Form 52), will be furnished on application to the Secre- 
tary. Copies of the Order may also be obtained. 
* This modification of the original order, which required Returns to he forwarded at 
the end of the first month, is made in order to give teachers more time to perfect th© 
Returns. 4 
In some localities the vaccination of school children had been 
enforced before the receipt of the certificates and blanks prepared by 
the Board. From some of these no reports have yet been received. 
As it is desired to ascertain the condition of the entire school popula- 
tion with reference t© this question, teachers, superintendents and 
other school officers cognizant of the facts are respectfully requested to 
inform the Secretary as to (1) the total number of scholars in any such 
locality; (2) the total number properly protected against small-pox; 
(3) the total number vaccinated or re-vaccinated within the past two 
years. Copies of the certificates in use, as well as of circulars, notices, 
etc., which have been issued, are also desired. 
It is suggested that School Boards might materially facilitate the 
enforcement of this measure, by embodying its purport in the form of 
one of their own regulations. They have the necessary power and 
authority to do this, and in the numerous instances where such a 
course has been pursued, it has worked very successfully. The State 
Board would prefer this, because, for one among other reasons, the 
school boards are in more intimate relation with the teachers and 
scholars. 
It is hardly necessary to again state that every teacher should com- 
ply with this requirement as fully as any scholar. School Boards are 
authorized to demand that each teacher employed shall present evi- 
dence of proper protection against the liability of conveying contagion 
into the midst of his or her pupils. 
The thanks of the State Board are tendered to the County Superin- 
tendents, School Boards and Teachers generally, for the cordial sup- 
port and cdoperation they have accorded to this effort. It is largely 
due to them that the school population of Illinois is undoubtedly better 
protected against small-pox than that of any State in the Union of the 
same age, and is probably not excelled in this respect by any of the 
older Commonwealths. 
By order of the Board : 
JOHN H. RAUCH, M. D., 
Secretary. 
County Superintendents may obtain additional copies of this 
Circular, if necessary, by addressing the Secretary. Its prompt and 
general distribution is respectfully urged.