An Estimate of the True Value o - T. M. Greenhow

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Title: An Estimate of the True Value ofVaccination as a Security Against SmallPox

Author: T. M. Greenhow

Release Date: July 18, 2015 [EBook#49475]

Language: English

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An Estimate of the True Valueof Vaccination

as a Security Against SmallPox

ANESTIMATE,

&c. &c.

Newcastle; Printed by T. & J.Hodgson,

Union Street

AN

ESTIMATE

OF THE TRUE VALUE OF

VACCINATIONAS A

SECURITY AGAINST SMALL POX.

BY

T. M. GREENHOW,

MEMBER OF THE ROYAL COLLEGE

OF SURGEONS IN LONDON;SURGEON TO THE LYING-INHOSPITAL, TO THE CHARITYFOR POOR MARRIED WOMEN

LYING INAT THEIR OWN HOUSES, AND TO

THEINFIRMARY FOR DISEASES OF

THE EYE, NEWCASTLE.

And in order to stimulate the wise andgood to aim strenuously at thisconsummation (the total extirpation ofSmall Pox), let it be constantly borne inmind, that the adversary they arecontending with is the greatest scourgethat has ever afflicted humanity. That it

is so, all history, civil and medical,proclaims; for though the term Plaguecarries a sound of greater horror anddismay, we should probably be withinthe truth, if we were to assert, thatSmall Pox has destroyed a hundred forevery one that has perished by thePlague.

Sir Gilbert Blane.

LONDON:

PRINTED FOR BALDWIN,CRADOCK, AND JOY; AND

EMERSON CHARNLEY,NEWCASTLE.

1825.

Preface.

My design, in entering upon the

following little work, has been to

collect, and to compress within as

narrow a compass as possible, the

principal facts and evidences upon

which the claims of Vaccination are

founded; that the public may be

furnished, in a concise but

comprehensive form, with the

information which is essential to their

forming a correct judgment on this

momentous question.

That much misapprehension and some

prejudice prevail on this subject, my

recent observation and experience have

convinced me; and when I reflect on the

pernicious effects, which, in Newcastle

and its neighbourhood, are at this time

taking place in consequence of them,

and which they must continue to

produce while they are permitted to

exist, I feel that a collective detail of the

evidence calculated to remove them is

much needed, and that, being sensible of

this, it becomes a duty incumbent upon

myself to endeavour to supply so

important a desideratum.

In making this attempt, I have been

desirous of avoiding any unnecessary

delay, and have therefore, perhaps, been

obliged to collect facts, and to deduce

arguments from them, with a degree of

haste, which, while it must have

occasioned many imperfections in the

execution of my design, will, I trust, be

admitted as some apology for such

defects: I am willing, however, to hope

that they will not be found of sufficient

magnitude materially to interfere with

the useful tendency of the estimate.

The works of those writers whom I

have consulted, and whose authority I

have quoted in support of the efficacy of

Vaccination, are familiar to the Medical

Profession, and, with scarcely an

exception I believe, its members have

drawn the same satisfactory conclusion

from the facts which are detailed in

them. But as these works, are, for the

most part, strictly professional, they

have not come before the public in

general, who have not, in consequence,

had equal opportunities of convincing

themselves of the true value of

Vaccination. It is, however, manifestly

more important, in proportion as their

relative number is greater, that the latter

should be convinced of this, than the

former only. The present estimate,

therefore, is more particularly intended

to satisfy the doubts, and to remove the

apprehensions of the community at

large; though I trust, should I in any

degree have succeeded in the attempt, it

may also be read by my professional

brethren not without some portion of

satisfaction and of approbation.

But, after all, should my object in

endeavouring to convince the more

enlightened parts of the community,

(from whom alone I can hope for a

proper consideration of the evidence I

have adduced,) be attained, much will

yet remain to be done: and I have

endeavoured to point out the necessity

of a general co-operation, in order to

give the fullest effect to the paramount

capabilities of Vaccination.Amongst

the poorest and least informed classes

of society, a written evidence of this

description, can scarcely be expected

either to gain access or to meet with the

requisite consideration; and the

ignorance, the prejudices, and the

apathy, which have been found to exist

in some of them, must therefore be

overcome by other means. It is my wish

to direct attention more especially to the

latter difficulty, having myself

witnessed some instances, and having

been informed of many others, wherein

the parents have regarded the health and

lives of their children so little, as not

only to despise the security afforded by

Vaccination, but to omit the most

ordinary precautions against Small Pox

infection, and to reject the gratuitous

medical assistance which was within

their reach.[1]

1. Mr. Wilkie (the respectableresident apothecary at theDispensary in this town) latelyinformed me that a woman, whoresides in Sandgate, after losingthree children from Small Pox,during the present prevalence of

that disease, would yet neitheruse precautions nor remedialmeasures for the preservation ofthe remainder; although she dailywitnessed the efficacy ofVaccination among herneighbours, even when performedduring the existence of Small Poxitself in other members of thesame families.

But there are links by which all the

various classes of society, from the

highest to the lowest, are connected; and

it is through the medium of these that we

must hope for the removal of the

difficulties referred to. There are few of

the rich, who have not the power of

influencing some of the poor, nor do I

believe there are any of the latter who

may not be influenced by some one or

other of the former. Whether this

influence may be exerted through

interest, through persuasion, or through

the conviction of reason, is a matter of

less moment than the attainment of the

end in viewnamely, to induce all,

without exception, to have their

children vaccinated during infancy

and were it employed in its fullest

extent, this end might certainly be

accomplished.

It hence becomes of the utmost

importance, that those should

themselves be convinced of the true

value of Vaccination, who may possess

the power, by whatever means (never

omitting, however, when possible, to do

it through the medium of reason) of

extending the operative influence of

their conviction to others. From the

wealthy, the intelligent, and the

educated parts of society then, I venture

to hope that the following Estimate will

meet with some serious consideration,

and that, in whatever degree it may

directly contribute to remove doubt, it

may, at least, excite such a spirit of

candid and deliberate enquiry into the

subject of Vaccination, as may

ultimately render its great value

universally acknowledged, and its

practice in every instance adopted.

Westgate Street, Newcastle,

November 20th, 1824.

AN

ESTIMATE,

&c. &c.

INTRODUCTION.

What reliance may safely be placed onVaccination as a means of exemptionfrom Small Pox?It may be affirmed, without hazard ofcontradiction, that no questionconnected with the physical well beingof mankind involves considerations ofmore serious interest, or consequencesof more vital moment, than that whichhas just been proposed. During the lastquarter of a century, it has engaged adegree of attention, both from medicalpractitioners and from society ingeneral, proportionate to the great

importance of the subject; and thoughamong the former, with very fewexceptions, one pretty uniform opinionmay prevail respecting the true value ofthe Jennerian discovery, I have reasonto know, that many doubts andapprehensions still linger in the mindsof not a few of the latter. These havebeen cherished or revived bycircumstances, of a nature, it must beadmitted, well calculated to shake theirconfidence in Vaccination as anabsolute preventive of Small Pox;which, unfortunately for the cause, on itsfirst introduction into practice, it wasgenerally believed and asserted to be;but which subsequent experience hasproved can no longer be contended for.

I trust, however, to be enabled to prove,to the satisfaction of every impartialenquirer, that the value of Vaccination isnot essentially diminished on thataccount; that an imperfect knowledge ofits effects can alone have given rise tothe doubts and apprehensions referredto; and that nothing is required for theirentire removal but a more intimateacquaintance with the subject. It is thepurpose of the present Essay, then, tobring under review the principal factsconnected with the history of Small Poxand of Vaccination which, in any way,bear upon the question proposed; toarrange them in such order, and to placethem in such lights, as may bestelucidate the subject, and enable those,

who have children not yet protected inany way from the infection of SmallPox, to form a clear and satisfactoryjudgment; a judgment unbiassed byprejudice, matured by a serious andcandid consideration of the evidencethat will be laid before them, and onwhich may depend life itself, or muchthat renders life desirable.I have been led to believe that such anattempt may at this time prove ofconsiderable service, in consequence offacts which have lately come under myown observation, and which haveinduced me to pay more attention than Ihad previously done to this singularlycurious and interesting subject.

The facts to which I allude are1st.The prevalence of Small Pox to aconsiderable extent in the town andneighbourhood of Newcastle, by whicha number of deaths among children, whohad not been vaccinated, has beenoccasioned.2dly. The occurrence ofthe disease in many individuals, whohad gone through the process ofVaccination; though in every instance asfar as I have been enabled to ascertain,it has been so mitigated in the violenceof the attack as to preclude any degreeof danger, and has never run the regularcourse of the genuine Small Pox.3dly.The impression, which theseoccurrences have made upon the mindsof those in whose families they have

taken place,an impression not onlyunfavourable to Vaccination, but whichhas induced some to entertain the ideaof again having recourse to inoculationfor Small Pox.And, 4thly. Theoccurrence of Small Pox itself a secondtime in an individual, who bore amplemarks of having already gone throughthat disease, which she stated to havetaken place naturally when young: thispatient was a servant in a family wherethree instances had occurred afterVaccination, and, as in them, the diseasewas of a mild and modified character.In all the cases of Small Pox afterVaccination which I have myselfwitnessed, or of which I have beenenabled to obtain any distinct account,

the disease has been of so mild acharacter, and so curtailed in itsduration, that could it have beenseparated from the terrific name ofSmall Pox, it would have excited noapprehensions in the minds either of thepatients themselves or of those aroundthem. But it unfortunately happens thatthis disease is associated in our mindswith so many terrific accompaniments(which were once indeed its constantattendants and consequences, and whichbelong to it in its natural form, butwhich, after the employment ofVaccination, have no existencewhatever), that it is difficult for themind to break through this association,and to feel satisfied that though Small

Pox may still appear as an occasionalvisitor, yet, to the vaccinated, it iscompletely stripped of all that renderedit dangerous in its attack and serious inits effects.I have had repeated opportunities latelyof pointing out this satisfactorydistinction to the parents of childrenwho were affected with Small Pox, bothafter Vaccination and when no suchprotecting influence had been employed.The contrast between the characters ofthe disease, as evinced in these differentindividuals, was too striking not tocarry immediate conviction to the mindsof all present; and I believe it has beenof considerable service in inducingmany to have their children vaccinated,

who would otherwise have omitted italtogether. These cases occurred amongthe lower orders of society; and I feelassured that this demonstrative proof ofthe utility of Vaccination will do moreto remove the prejudices of thesepeople than any abstract reasoning fromfacts of which they have not themselvesbeen witnesses, however numerous andwell authenticated. I should, therefore,strongly recommend it to everypractitioner to take advantage of anyopportunities that may be afforded himof pointing out this most markeddistinction between the natural andmodified Small Pox.

CHAP. I.

We shall best estimate the value of anymeans of removing an evil, byenquiring, in the first place, into theextent of the effects of the evil which itis our object to remove. And we shallalso form the most correct estimate ofthe value of the means which have beenemployed for its removal entirely, or inpart, by reverting to its extent previousto the employment of such means, andcomparing the amount of its former illconsequences, with those which are stillproduced by it.To satisfy ourselves on the subject of

the present enquiry then, it will beuseful to put the following queries:1st. What were the destructiveconsequences of Small Pox previous tothe introduction of Vaccination? And,2ndly, What influence has Vaccinationexerted over these consequences1. byextensively superseding the causeand2. by essentially interfering with theeffect?To answer the former questionsatisfactorily, it will be necessary toenter, at some length into the history ofSmall Pox, before Vaccination wasproposed as a means of prevention. Butit will be remembered, that previous tothat era, a means had been already longin use, for the purpose of diminishing, at

least, the danger of this terrific disease;and that for half a century the Small Poxhad been communicated to thousandsannually by inoculation, with the viewof accomplishing this very desirableend. This will naturally give rise to asecond division of the history of SmallPox. Our first enquiries will thereforebe directed to the time antecedent to theuse of inoculation for Small Pox, whenno artificial measures were adopted forprotecting mankind from its fatalattacks.Although from the vague accounts whichearlier European writers have given ofthe diseases which came under theirnotice, it is not always easy todistinguish very accurately the precise

extent to which Small Pox proved fatalamong the nations of Europe, it is yetpretty certain that for a thousand[2] yearsbefore inoculation was introduced, itwas one of the most destructivescourges of the human race, frequentlydestroying thousands and tens ofthousands, in any district where itoccurred. It was at this time frequentlyincluded under the general term plagueor pestilence, which was applied toevery destructive epidemic that tookplace. It is not necessary, however, formy present purpose to go back to theseremote ages; for, independent of theimpossibility of obtaining sufficientlyauthentic information whereon to foundany accurate argument, it is not to be

doubted that the fatality of Small Pox, incommon with that of every otherdisease, would then be materiallygreater than in the present day, inconsequence of the want of cleanlinessand ventilation in our cities and houses,and of good medical treatment. It willnot be difficult, however, to produceample proof of the great mortalityoccasioned by this disease, at a periodwhen these disadvantages were lessfelt, and when the nature of it wassufficiently certain. For this purpose Ihave drawn up tables from the bills ofmortality of London, comprising aperiod of 120 years, viz. from 1703 to1823, which will form the basis of myarguments.

2. According to Mr. Moore,(History of Small Pox, p. 66-7)the Small Pox was firstintroduced into Europe during theinvasion of Spain by theSaracens, in the commencementof the eighth century: after which,the infection rapidly spread intoFrance and other countries.

Mr. Moore, in his History of Small Pox,(p. 243) tells us that Dr. Jurin took thelead in replying to the opponents of thispractice (inoculation for Small Pox):and being a calm man, well skilled incalculation, his writings werecomposed with great good sense and

good temper. He drew his argumentschiefly from an accurate examination ofthe London bills of mortality for forty-two years, and from accounts collectedfrom a few large cities: and hecompared the numbers who died of theSmall Pox with the general mortality.From all which he concluded,That of all the children that are bornthere will, some time or other, die of theSmall Pox, one in fourteen. And thatof persons of all ages, taken ill of thenatural Small Pox, there will die of thatdistemper one in five or six.In other countries this disease appearsto have been yet more fatal than inEngland. I shall, however, revert to the

documents which I have myselfcollected on the subject.The tables, which I have constructed,embrace a period of 20 years beforeinoculation was at all employed in thiscountrythe whole period duringwhich it was in useand the timewhich has elapsed since theintroduction of Vaccination. We shallthus be enabled, at a single glance, tocompare the mortality of Small Poxunder each of these severalcircumstances. In the first column of thetable (No. 1.) is shewn the total numberof deaths which occurred within thebills of mortality during eachsuccessive year, and in the secondcolumn, the number occasioned by

Small Pox alone.The table (No. 2.) is divided intoperiods of five years eachit consistsof four columnsthe first of whichexhibits the total number of deathsduring each period of five yearsthesecond the number of deaths from SmallPoxthe third shows the proportion ofthe latter in each thousand of the formerand the fourth points out the relativeproportion of deaths from Small Poxcompared with the whole. I am awarethat the two latter columns may beconsidered as a repetition of the samestatement, but I think it may appear morestriking when placed in this doubleform.

When we compare the calculation of Dr.Jurin, which has been quoted above,(published I believe about the year1723,) with the first twenty years ofthese tables, we shall find, that, with theexception of the first five years, it israther below than above the resultswhich they exhibit; that, according tothem, for the fifteen years from 1708 to1723 inclusive, the deaths from SmallPox exceeded one in twelve of thewhole,that in 1710 it was about onein seven, and that in 1719, although therelative number was not quite so great,being in the proportion of one in eightonly; yet that the actual number wasgreater than in 1710, amounting to nofewer than 3229, the total number of

deaths being 28,347.Such was the destructive nature ofSmall Pox before the introduction ofinoculation. Its ill effects, however,were not confined to those whom itprecipitated into the tomb. A very largeproportion of the living, who werefortunate enough to escape its fataleffects, yet suffered essentially for theremainder of their lives from itsinjurious attacks, not only in the loss ofthat beauty of countenance which we allvalue both in ourselves and in ourfriends, but frequently in the seriousinjury or total destruction of one or botheyes,[3] or of the general health of theconstitution, which was, in many cases,never afterwards entirely restored,

although death was not the immediateresult.

3. It appears, by a report of theHospital for the Indigent Blind,that two-thirds of those whoapply for relief, have lost theirsight by Small Pox,Sir G.Blane on Vaccination, p. 9.

Instances, wherein the beauty of thehuman countenance has been materiallyinjured by the occurrence of Small Poxin the early stages of life, are nowhappily much more rare than formerly,especially in the higher ranks of society,and I trust will, in the course of another

age, become entirely unknown. Thereare few of us, however, who are notstill acquainted with some, and whocannot recall many more: and we everynow and then meet with cases ofblindness, which had succeeded to thisformidable disease. I have myself hadopportunities of seeing several suchinstances; and it is but a few weekssince my opinion was asked respectinga child, who was recovering from theSmall Pox in its worst form, with acountenance dreadfully disfigured, andone eye entirely destroyed.[4]

4. Since this was written, I havebeen consulted on account of a

little girl, of seven years of age,who has just sustained the samevery serious deprivation, inconsequence of an attack of SmallPox.

That a disease so destructive of humanlife, and which frequently entailed onthe living such indelible proofs of itsseverity, should have been anticipatedwith peculiar feelings of dread andapprehension we can well believe, andit was natural that any method, whichafforded a probability of diminishing itsdanger, and of rendering its attacks of amilder character, should excite noordinary degree of public attention.

How far these ends were accomplishedby the artificial communication of SmallPox by inoculation, we shall nowproceed to inquire.

CHAP. II.

The first individual in England onwhom the operation of inoculation forSmall Pox was performed, was thedaughter of the celebrated Lady MaryWortley Montague. She had witnessed,when in Turkey, the mildness of thisdisease as produced by inoculation, andher son had already passed through theprocess with safety. The engraftment ofher son having succeeded; after Lady M.W. M. returned to London in 1722, shesent for Mr. Maitland, the surgeon, whohad attended the boy at Constantinople;and desired him to engraft her daughter

with Small Pox. He solicited a delay, onaccount of the weather, and entreatedthat two physicians should be consulted.These requests were refused, yet heobeyed her Ladyships injunctions; butwhen the fever commenced, an oldfamily apothecary and three physicianswere permitted to witness the process.As the success was complete, Dr. Keith,one of the above physicians, wastempted to request Mr. Maitland toengraft his child also, which likewisesucceeded; and these cases wererumoured through the town.[5]Anexperiment was afterwards tried, at therequest of the Princess of Wales, uponsix condemned felons with success,and her own children passed through the

operation with safety. After this,inoculation was partially employed forsome years, and was again discontinuedbut, about the middle of the lastcentury, great exertions were made tobring it into general use, and with aconsiderable degree of success. Weshall presently endeavour to ascertainwhat influence it exerted over theprevalence and fatality of Small Pox.But, in the first place, I think it will beuseful to enquire into some of thearguments which were adduced insupport of the practice; and, it may be,to allude to a few which were opposedto it.

5. Moores History of Small Pox, p.228-9.

The principal arguments, on which theemployment of inoculation for SmallPox was supported, appear to have beenthe following:1. The infectious nature of the disease,which was so virulent as to permit fewindividuals to pass through life withoutbeing at one time or other affected by it.2. Its fatalitydestroying at least one infive or six of those attacked by it.3. The generally received opinion thatno individual could be affected by itoftener than once. And

4. That, when communicated byinoculation, it was renderedcomparatively mild and devoid ofdanger, while it afforded equal securityagainst any future attack of the disease.The two former of these positions neednot engage our attention in this placethe highly infectious nature of Small Poxhas always been admitted; and I havealready brought forward sufficient proofof the danger to human life which itoccasions.The third proposition is of mostmaterial importance; for I am wellconvinced that upon a properunderstanding of this question dependedthe true value of inoculation as far as

regarded individuals; and on it alsorests the true value of Vaccination asregards society in general.It was unfortunate for the cause ofinoculation that its early advocatesmaintained the absolute impossibility ofSmall Pox occurring a second time inthe same individual. They thus furnishedtheir opponents with weapons againstthemselves, in the cases, whichrepeatedly occurred, of those who hadpassed through the process ofinoculation being afterwards affected bythe natural Small Pox; and were put tothe necessity of having recourse toexpedients equally unmanly anduncandideither of denying that thesecond disease was genuine Small Pox,

or of asserting that the inoculatingprocess had been imperfectlyperformed. Whereas a little attentiveobservation and research into theformer history of Small Pox, might havesatisfied them, that although in a greatmajority of cases this formidabledisease did not occur a second time inthe same person, yet that repeatedinstances took place wherein it did sooccur. And that while it might beassumed as a general rule that the sameindividual would be affected once onlywith Small Poxit was a rule admittingof exceptions.That a second attack of Small Pox maytake place in the same individual, maybe proved by a mass of evidence which

appears to me to be perfectlyirresistible; and as I consider it veryimportant to the object of this enquirythat every doubt should be removed onthe subject, I must be permitted to dwellon it longer perhaps than may at firstsight appear necessary. I have greatpleasure in acknowledging myobligation to the valuable HistoricalSketch of Small Pox, by ProfessorThomson of Edinburgh, for a large shareof the evidence which I shall lay beforemy readers, to prove the frequency ofthe recurrence of Small Pox. Soon afterthe introduction of inoculation intoFrance, a son of M. Delatour, aboutnine years of age, was inoculated in1756 for Small Pox, by Surgeon Martin,

under the inspection of M. Tronchin,and passed through the disease in asatisfactory manner. This boy remainedin good health for upwards of twoyears, when an eruption, supposed bysome to be Small Pox, appeared uponhim, as well as upon four of hiscompanions in the same boarding-school. The different opinions formedof the nature of this eruption by themedical practitioners who saw it, andwho seem to have judged of itaccording to the preconceived notionsthey entertained with regard to thepossibility of the recurrence of SmallPox, present (says Dr. Thomson) so truea picture of what has occurred insimilar cases since the introduction of

Vaccination, and of the manner in whichdoubtful cases of varioloid eruptionscontinue still to be judged of, that Icannot avoid giving you an abstract ofthe discussions to which this case gaverise.[6]Dr. Thomson goes on to say,that M. Gaulard, Physician in ordinaryto the King, was called to see the son ofDelatour on the third day of theeruption, which he declared to be amild case of Small Pox, of the kindcommonly called, he says, thoughimproperly so, Chicken Pox, and thedisease in the boys companions heconsidered of the same nature.Fourphysicians were called in to consultwith Mons. Gaulard, who[7] gave anaccount of the progress of the disease

which contains a description ofvarioloid eruptions, very similar tothose which have of late been describedunder the denomination of modifiedSmall Pox.

6. Dr. Thomsons Sketch, &c. p. 53.

7. Dr. Thomsons Sketch, &c., p. 54.

These gentlemen mention also, that twoof the other children affected, hadpreviously passed through natural SmallPox; and conclude with declaring that,from these circumstances, they believethat the disease in Delatour and hiscompanions, was neither the Small Pox

nor the Chicken Pox, but a chrystalineeruption, with which they were wellacquainted.It is, I think, from this sufficientlyevident, that nothing but thepreconceived opinions of the physiciansconsulted in these cases could haveprevented their acknowledging the truenature of the disease; and there cannot, Iconceive, be a doubt, that it was noother than Small Pox rendered milder inits character by the previous occurrenceof it in these children. It is ofimportance too to remember that theyafford examples of the recurrence of thedisease after both natural andinoculated Small Pox. Delatour hadbeen inoculated upwards of two years

before, and two of the other childrenaffected had previously passed throughnatural Small Pox. I shall here adducesome further extracts from Dr.Thomsons work. He tells us that M.Hosty, who had been sent over toEngland in 1755, to acquire informationupon the subject of inoculation, entersinto a discussion with respect to therecurrence of secondary Small Pox, inwhich he allows that there are severaleruptive diseases with which a personmay be affected, so like the Small Pox,as scarcely to be distinguishable fromthem, and, on that account, liable togive rise to many mistakes; and hestates, that although he does not denyabsolutely the possibility of the

recurrence of Small Pox, he believesthis to be rare, (p. 55-6). To Hostysopinion, with regard to the unfrequencyof the occurrence of secondary SmallPox, Gaulard replied, that he had at thattime under his charge two unequivocalexamples of secondary natural SmallPox, and that a nephew of theArchbishop of Paris, had a monthbefore passed through the Small Pox,under the care of the celebrated M.Astruc, although he bore marks on hisbody of having formerly undergone thedisease.(p. 59.)Gaulard then declares, that thoughreason dictates, and experienceactually demonstrates, that this process(inoculation for Small Pox) does not

infallibly afford protection against asubsequent attack of natural Small Pox,he was still disposed to believe that itmay be possessed of some realadvantages (p. 59). Dr. Cantwell, in1755, published a dissertation uponinoculation, the avowed object of whichwas to undeceive those who believed inthe efficacy of that practice. In thisEssay, a great number of cases of SmallPox, which had occurred both afternatural and inoculated Small Pox, arementioned (p. 64). He (Dr. Cantwell)seems to have been well acquaintedwith those varioloid eruptions which,previous to the introduction ofinoculation, had received a variety ofnames, such as Swine Pox, Chicken

Pox, &c. and which were considerednot as specifically different from SmallPox, but as spurious and bastard speciesof that disease. These eruptions, in hisopinion, were nothing else than mildvarieties of the true Small Pox. His ownwords are (p. 37), after all, what arethe Swine Pox, the Duck Pox, and theChicken Pox, which are observedamong the English and the Irish? Whatis the petite verole volante which isseen in France? Many distinguishedauthors attest, that they have seen SmallPox occur twice in the same individual;and have not we reason to believe that,in these cases, the second attack wastrue Small Pox, of which the infectionwas slight, and in which the vital

actions were too weak to carry it to acertain extent? All this appears to memost strictly consistent with truth. ButDr. Cantwell was arguing against theuse of inoculation. How then did heaccount for the fact that the infectionwas slight, and that the vital actionswere too weak to carry it to a certainextent, if it did not arise from theseindividuals having already passedthrough the disease of Small Pox?De Haen (a celebrated physician ofVienna,) says Dr. Thomson (p. 68),collected into a body the numerouscases of secondary Small Pox, whichare to be found in the writings ofphysicians, who lived previous to, andin the infancy of, the practice of

inoculation in Europe. Had the numberof these cases, and the respectability ofthe individuals by whom they arerelated, been duly considered, theysurely were more than sufficient to havesatisfied the minds of the mostincredulous, of the possibility, and evenof the frequency of secondary SmallPox. De Haen, however, was anopposer of inoculation, and the facts headduced were not permitted to have theweight which they merited, inconsequence of the arguments hededuced from them.I shall conclude my extracts from thefund of evidence collected in the workof Professor Thomson, with thefollowing:

M. Strack, professor of medicine atMayence, in a letter upon inoculation,addressed to M. Roux in 1765, (Journ.de Med. tom. xxii.) maintains thatnatural Small Pox do not, any more thanthe artificial, protect against a secondattack. In proof of his opinion, hementions six cases of secondary SmallPox which he himself had attended. Theargument which he uses in support ofinoculation, in opposition to those whowere hostile to that practice, and whoasserted that it does not protect againsta subsequent attack, though novel at thetime it was employed, has since beensufficiently confirmed by repeatedobservation. He says, that those whohave passed through the Small Pox

twice, whether naturally or artificially,have, in general, escaped withoutdanger; those patients, he adds, whohave had the Small Pox at two differentperiods, are fortunate, because if thevariolous miasma had operated with itsfull force during the first attack, theyprobably would have fallen victims tothe disease (p. 77).Mr. Moore remarks (Hist. of Small Pox,p. 278) that, besides the foreignauthorities, the English MedicalJournals contain several authenticexamples of persons whose faces werestrongly pitted with Small Pox, and whowere afterwards destroyed by a secondattack of that disease,he goes on (p.279) to relate an incident frequently

repeated by the late Dr. Reynolds,Physician to his Majesty, who was sentfor by a lady unknown to him, andconducted by her maid, rathermysteriously, into a handsome bed-chamber; where he saw, lying in asplendid bed, a lady masked. Being agood deal surprised, the maid stifled alaugh, while her mistress, in a soft tonedvoice, apologised for concealing herselfeven from a professional gentleman.This (she said) had become proper,from the peculiarity of her situation. Atpresent she stood greatly in need of hissuperior medical talents, and wasextremely anxious for his opinion on hercase, which she understood from others,was a very rare one. The doctor being

thus put upon his guard, enquiredminutely into all the symptoms, andexamined critically a pustular eruptionwhich was spread over the ladysperson: he then pronounced the diseaseto be, without all doubt, the Small Pox.On which the patient unmasked, anddisplayed features seamed with thedisorder.Dr. Thomson (in his Historical Sketch,p. 279) informs us, that out of eighthundred and thirteen cases of SmallPox, which had come under his noticesince June, 1818, seventy-one hadpreviously passed through Small Pox.And in the sequel many other instanceswill be referred to.

In a late number of the London MedicalRepository, Dr. Carter, of Canterbury,gives the details of a case of secondarySmall Pox occurring in a girl, whichproved fatal. And a young lady (afamily connection of my own), who hadsatisfactorily passed through thedisease, from inoculation, when young,had a second attack of Small Pox, whenon a visit at Liverpool, to which shevery nearly fell a sacrifice. To this massof evidence I shall add the case towhich I have before alluded, as havingcome under my own notice. In thisyoung woman the eruption was confinedto the shoulders and face, and was notnumerous, but it was preceded forseveral days by considerable

feverishness and head-ache; andalthough it did not proceed beyond thefourth or fifth day, I consider the natureof the disorder as quite unequivocal; ifwhat I conceive to be the only true testof this be admitted, namely, that it wasproduced by Small Pox infection, andwas capable of communicating it toothers. Fortunately this test was leftincomplete in this instance, no otherindividuals having become infected inconsequence; but the following factswhich have since come to myknowledge, seem to warrant theinference, that this might have happenedhad any unprotected persons beenallowed to have communication withthe patient.

A lady, residing at Gateshead, whopassed through inoculated Small Poxmany years ago, became lately (duringher confinement) affected a second timewith this disease. And notwithstandingthat it was of the same mild character asin the last case, and that the eruptionturned on the eighth day, her infantcaught the infection. The eruption in thechild was of the confluent kind, andoccasioned its death eight days after theappearance of the disease.Having succeeded, I trust, in proving tothe entire satisfaction of every candidenquirer the possibility, if not thefrequency, of the occurrence of SmallPox a second time in the sameindividual, it would be both interesting

and useful, were it possible to ascertainwhat proportion such cases bear tothose who escape a second attack; butmany insurmountable difficultiespresent themselves in making such acalculation. Dr. Thomson tells us (p.67), that according to Tissot, theproportion of cases of secondary SmallPox, is as 1 in 100; according toHeberden, as 1 in 5000; and, accordingto Condamine, as 1 in 10,000. Howuncertain the data!It is, however,enough to know, that while the relativenumber is sufficiently great to preventthe rule, That no individual can beaffected by Small Pox oftener than once,from being considered absolute, it isyet too small reasonably to shake our

confidence in the fact, that a very largeproportion will escape a recurrence ofthat disease. One other fact ofconsiderable importance has, I trust,been also established by the precedingenquiryThat when secondary SmallPox does take place, it is usually a verymild disease, unattended with danger.The fourth argument in support of theemployment of inoculation for SmallPox,that it was renderedcomparatively mild and devoid ofdanger, while it afforded equal securityagainst any future attack of the diseasewith natural Small Pox itself, need notdetain us long.The latter part of theproposition has been generallyadmitted; and its truth or falsity will not

affect the object of our present enquiry.Mr. Moore (History of Small Pox, p.302) tells us, that at the commencementof inoculation in England, theproportion of fatal cases appears tohave been fully one in fifty. But after thelast improvement in treatment had beenestablished, probably not more than onein two hundred were lost.Mr. Moorecontinuesof those who contract thecasual Small Pox, and are treated withmedical care, it has been admitted thatgenerally about one in six are lost: butin countries where the medical arts areunknown, the Small Pox is so fatal adisease that few of those who are seizedwith it survive its malignity. Theimmense difference between these

proportions is amply sufficient to provethe great advantage derived frominoculation by those on whom it waspractised.Such then were the data on which thepractice of inoculation for Small Poxwas established. But it will beremembered, that on its introduction,and for many years after it had beenextensively used, it met with a verywarm opposition both from medicalmen and others, especially from somezealous divines, who stigmatised it asa diabolical invention of Satan, anduttered anathemas against all whoshould practise it. I shall not enter intoany examination of the arguments madeuse of by the opposers of inoculation;

some of them have been already alludedto, and their fallacy pointed out. Takenaltogether, it is remarkable how nearlythey resembled those which have beenopposed to the introduction ofVaccination. Now, that distance of timehas enabled us to view the facts of thecase with coolness, and to reason uponthem without prejudice, while we admitthe individual security which arosefrom the practice of inoculation, wemust in candour confess its tendency toencrease the general destruction of lifefrom Small Pox, by forming so manynew sources of infection. This was theonly rational argument againstinoculation, but it was certainly one ofgreat force, and the actual encrease of

deaths from Small Pox during theprevalence of inoculation, seems toprove that it was never sufficientlyconsidered. The encreased number ofdeaths from Small Pox in 1723 and1725, might fairly be imputed to thiscause, although it was denied at the timeby Dr. Jurin. Mr. Moore (History ofSmall Pox, p. 243) very satisfactorilyreplies to Dr. Jurins argument in thefollowing extract. And as in the year1723 a great increase of the mortality bySmall Pox took place in London; Dr.Jurin expressed his opinion that thisought not be imputed to inoculation, asthe numbers who had been inoculateddid not exceed sixty. This was a veryinadequate answer. A single person may

bring the plague into a town or into anation, and be the cause of thedestruction of an innumerable multitude.The Small Pox is fully as infectious adisease as the plague; and sixtyinoculations were more than sufficientto account for the augmented mortality,and were probably the cause of it.If we refer to the tables (No. 1 and 2),we shall find that from the years 1752 to1798 inclusive (the period during whichinoculation was most extensivelyemployed in this country), the averagemortality from Small Pox, duringperiods of five years each, wasoccasionally so high as one in eight ofthe whole, and rarely less than one inten. And that during individual years, it

three times (in 1752, 1781, and 1796)amounted to nearly one in five; and in1772 was little less than one in six. Thisis surely a fearful encrease on Dr.Jurins calculationThat of all thechildren that are born, there will sometime or other die of Small Pox one infourteen. There can be no doubt,however, that this immense encrease ofmortality from Small Pox was owing tothe extended practice of inoculation;and until this could have been pursuedmore generally, and with greaterprecautions, so as at once to diminishthe numbers capable of being infectedby the inoculated, and the hazard of thelatter coming into contact with theunprotected, I am disposed to think this

fact was in itself sufficient ground fordiscontinuing inoculation for Small Poxaltogether. Could every child have beensubjected to the process of inoculation,before any exposure to the infection ofnatural Small Pox had taken place, thecase would have been widely different:but it can scarcely be considered eitherjust or politic to render one individualsecure at the risk of endangering many,or with a certainty of destroying some.It may fairly be concluded, then, thatinoculation for Small Pox, as practisedfor the last fifty years of the eighteenthcentury, although certainly a greatindividual good, was, in reality,without a doubt, a most serious generalevil.

From what has been hitherto stated, Iconceive, we are authorised inassuming the following as facts, whichwill furnish a satisfactory answer to thefirst of the questions proposed, Whatwere the destructive consequences ofSmall Pox previous to the introductionof Vaccination?1. Small Pox is a disease of soinfectious a nature, that few individualspassed through life without sufferingfrom an attack of it.2. It was attended with so much dangeras to occasion the death of one in fiveor six of those affected by it in thenatural way; and previous to the use ofinoculation, one in fourteen of the whole

number of children born, at one time orother, died of the Small Pox.3. Of those who recovered, manysuffered materially from its effects, notonly in the disfigurement of countenanceoccasioned by it, but frequently in theloss of one or both eyes, or inirreparable injury of their constitutions.4. After having been once affected bySmall Pox, a very considerableproportion of individuals resist entirelya second attack: but still in very manyinstances a recurrence of the disease isproved to have taken place.5. Secondary Small Pox is, for the mostpart, very mild in its symptoms, and ofshorter duration than a first attack,

insomuch as to have frequently givenrise to doubts respecting the real natureof the disease.6. Secondary attacks of Small Pox have,nevertheless, occasionally proved fatal.7. When artificially produced byinoculation, the Small Pox is renderedmaterially milder in its character, sothat one in two hundred only of those towhom the disease has been thuscommunicated, have been found to diein consequence.8. The Small Pox, when communicatedby inoculation, is probably as secure apreventive of any future attack of thedisease as when it has taken placenaturally.

9. Notwithstanding the undeniableadvantages which accrued to those whopassed through the process, it was,nevertheless, the direct effect ofinoculation, by multiplying the sourcesof infection, materially to encrease theaggregate mortality occasioned bySmall Pox.

CHAP. III.

Such having been proved to have beenthe destructive consequences of SmallPox, previous to the introduction ofVaccination, we are fully prepared toenter upon the second query proposed,What influence has Vaccinationexerted over these consequences1. byextensively superseding the causeand2. by essentially interfering with theeffect?The name of Dr. Jenner is too intimatelyassociated with the subject ofVaccination to admit of the latter beingreferred to without some allusion being

made to the former; and I should illtestify my sense of the truly valuableblessing which Jenner has been themeans of conferring upon mankind,were I altogether to omit any expressionof my admiration of the superiorperception which enabled him to inferthe probable consequences of facts,which must have been long familiar tohundreds without having given rise toany important suggestion, and of the zealand ability with which he prosecutedhis enquiries on the subject, or my highesteem for the generousdisinterestedness with which he madeknown to the world his most usefuldiscovery. It will, (to use the wordsof Sir Gilbert Blane,) in the eyes of

future ages, be deemed an epocha in thedestinies of the world, and one of thehighest boasts of the country in which ittook its rise, with a sense ofunrequitable obligation to the individualwho first disclosed and promulgated thesecret, by drawing it from the darkrecesses of rural tradition, andrendering it available to the wholehuman race.It is not, however, my intention to enterinto any detail of the mode in whichVaccination originated, or of thecircumstances which accompanied itsintroduction into practice. It will sufficeto state, that its supposed efficacy inpreventing the occurrence of Small Pox,was founded upon repeated

observation, that the milkers employedin the great dairies of Gloucestershireand the neighbouring counties, whobecame affected with a disease whichprevailed among the cows, and to whichthe name of Cow Pox had been given inconsequence, were very generallyrendered insusceptible of the Small Poxinfection, even when attempted to becommunicated by means of inoculation.Dr. Jenner put this fact to the test ofrepeated experiment, and finding it thusconfirmed, proposed introducing theCow Pox into the human constitutionartificially, as a means of securing itagainst the dangers of Small Pox, and,in the end, of entirely exterminating thelatter disease; for it must appear very

evident, that if every individual could inany way be rendered incapable of beinginfected by Small Pox, the infectionitself must necessarily become entirelyextinct.In prosecuting my enquiries into thispart of my subject I shall, as far as maybe, confine myself to an examination offacts calculated, as I conceive, toremove every reasonable doubtrespecting the true value of Vaccination.The first essential fact, to which Iwould direct the attention of myreaders, is the very striking diminutionin the number of deaths from Small Pox,which has taken place within the bills ofmortality of London, since the

introduction of Vaccination. Thisdiminution is equally remarkable,whether we refer to the actual numberof deaths from this cause, or to therelative proportion which they bear tothe whole amount of deaths occurring inany given year or number of years. Thustaking the averages calculated onperiods of five years each, as is shewnin the table (No. 2), it will appearevident not only that the amount ofdiminution has been most gratifying andsatisfactory, but that, in proportion tothe increasing employment ofVaccination, it has been regularlyprogressive; so that the number ofdeaths from Small Pox, instead ofamounting to one in ten of the whole, as

was the case for the ten years whichpreceded the introduction ofVaccination, has during the last tenyears, actually amounted to less thanone in twenty-eight, or little more thanone-third of the former proportion.If we compare the number of deathsfrom Small Pox, which took placeduring the twenty-five years (from 1784to 1798 inclusive) which immediatelypreceded Vaccination, amounting to46,996, with the number which hastaken place during the twenty-five yearswhich have elapsed since itsintroduction (from 1799 to 1823inclusive), amounting to 25,869, weshall find that an actual diminution hastaken place of no fewer than 21,127, or

nearly one half of the whole. It may,therefore, be confidently assumed, evenupon this very simple calculation, that anumber of lives equal to this diminutionhas been saved by Vaccination, withinthe bills of mortality alone. And as thisdiminution in the amount of mortalityfrom Small Pox is going on in aprogressive ratio, it is probable that thenext twenty-five years will afford a yetmore striking result.If we extend this calculation to thewhole of Great Britain and Ireland,assuming that the ratio in the diminutionof deaths has been the same over theunited kingdom as within the Londonbills of mortality(and there arevarious good reasons for believing that

it has been greater)we cannot but bestruck with the immense saving ofhuman life which has already takenplace. Sir Gilbert Blane and Dr. Letsomseparately calculated the annual loss oflives from Small Pox, in Great Britainand Ireland, during the last thirty yearsof the eighteenth century.One of theseeminent physicians estimated them at34,260, and the other at 36,000(Moores History of Small Pox, p. 300):For our present purpose, we will take amedium number, as being probablynearest to the truth. Assuming then, thatthe number of deaths from Small Pox, inthe United Kingdom, during each of thetwenty-five years which preceded theintroduction of Vaccination, amounted to

35,000, the amount, during the whole ofthat period, must have been 875,000.But if the diminution on the whole ofthis number has been equal to that whichis proved to have taken place within theLondon bills of mortality, during the lasttwenty-five years, it must have beenreduced to 481,644 only, and an actualsaving of the lives of 393,356individuals must have beenaccomplished.These calculations agree pretty nearlywith estimates published in the year1820, by Sir Gilbert Blane, founded onsimilar documents. His calculationsextend to the parishes not includedwithin the bills of mortality, and hecomes to the following conclusion on

the subject:It appears, therefore, thateven under the very imperfect practiceof Vaccination, which has taken place inthe metropolis, 23,134 lives have beensaved in the last fifteen years, accordingto the best computation that the dataafford(Sir G. Blane on Vaccination,p. 7). But however remarkable andsatisfactory this immense saving ofhuman life, in the country whereVaccination originated, may appear, asan unanswerable evidence of itsefficacy, the result has been still moredecisive in many foreign countries,where it has been much more generallyemployed. In proof of this, I shall againquote the very valuable little work ofSir Gilbert Blane, (which, by the way, I

should strongly recommend to theattention of the public, as containingmuch valuable matter and soundargument within a very small compass).He states, (p. 7-8) In the summer of1811, the author was called to visit,professionally, Don Francisco deSalazar, who had arrived a few daysbefore in London, on his route fromLima to Cadiz, as a Deputy to theSpanish Cortes. He informed him, thatVaccination had been practised with somuch energy and success in Lima, thatfor the last twelve months there hadoccurred not only no death from, but nocase of, Small Pox: that the new bornchildren, of all ranks, are carried asregularly to the Vaccinating house as to

the font of baptism; that the Small Pox isentirely extinguished all over Peru;nearly so in Chili; and that there hasbeen no compulsory interference on thepart of the government to promoteVaccination.Sir Gilbert goes on to say, that it isnow matter of irrefragable historicalevidence, that Vaccination possessespowers adequate to the great endproposed by its meritorious discoverer,in his first promulgation of it in 1798,namely, the total extirpation of SmallPox. The first proof of this was atVienna, where, in 1804, no casesoccurred, except two strangers, whocame into the city with the disease uponthem. In 1805 there did not occur a

single death from it in Copenhagen. Dr.Sacco, the indefatigable superintendentof Vaccination in Lombardy, stated inhis annual report, 3d January, 1808, thatthe Small Pox had entirely disappearedin all the large towns in that country;and that in the great city of Milan it hadnot appeared for several years. Dr.Odier of Geneva, so favourably knownfor his high professional, scientific, andliterary acquirements, testifies that, aftera vigorous perseverance in Vaccinationfor six years, the Small Pox haddisappeared in that city and the wholesurrounding district; and that, whencasually introduced by strangers, it didnot spread, the inhabitants not beingsusceptible. The central committee in

Paris testify, in their report of 1809, thatthe Small Pox had been extinguished atLyons and other districts of France.These are selected as some of theearliest and most remarkable proofs ofthe extirpating power. But it isdemonstrable, that if at the first momentof this singular discovery, at anymoment since, at the present or anyfuture moment, mankind weresufficiently wise and decided tovaccinate the whole of the humanspecies, who have not yet gone throughthe Small Pox, from that moment wouldthis most loathsome and afflicting of allthe scourges of humanity, beinstantaneously and for ever banishedfrom the earth. (p. 8).

These, and such as these, then are thegreat, the undeniable facts, which must,I think, carry irresistible conviction toevery reflecting and unprejudiced mindrespecting the true value of Vaccination.And it is these facts which furnish uswith an answer to the second questionproposedWhat influence hasVaccination exerted over the destructiveconsequences of Small Pox? which itmust be truly gratifying to everyphilanthropic mind to contemplate. Inthe course of twenty-five years, in ourown country, where it has been verypartially employed, it has actually beenthe means of saving a number of lives,amounting to 393,356; and if it be true,as supposed by Sir Gilbert Blane, that

Small Pox induced blindness,deformity, scrofula, or brokenconstitutions, in as many whorecovered from the disease as died inconsequence of it, then have an equalnumber been saved from these dreadfulcalamities. But abroad, where it hasbeen more generally employed,Vaccination has, in many places,actually exterminated the Small Poxaltogether.From what has already been said, itwill be evident, that Vaccination hasproduced these very beneficialconsequences in two ways. 1. Bysuperseding an efficient cause of thespread of infection, namely, the practiceof inoculation for Small Pox. And 2. by

essentially interfering with the effect ofthe infectious virus.The increased number of deaths, whichtook place during the period wheninoculation for Small Pox was generallyemployed, is sufficient to prove theinfluence of Vaccination to have beenconsiderable in the former way; but aformal application having been made tome to inoculate a child for Small Pox,since I commenced these remarks, Ithink it right to call the attention of thepublic more decidedly to the pernicioustendencies of the practice.The attention of the medical profession,and of the public generally, was soonexcited by the increasing number of

deaths after the introduction ofinoculation, and exertions were made tocheck it, particularly by theestablishment of the Small PoxHospital. This, no doubt, had someeffect, by separating a part at least ofthose to whom Small Pox wasartificially communicated from the restof the community; but the event provedthat this was by no means an adequatedefence against the factitious causes ofinfection, which were daily called intoaction. The Small Pox Hospital stillexists, and it is a very remarkable fact,that, for several years after thediscovery of Vaccination, out-patientscontinued to be inoculated at thatinstitution. This, no doubt, contributed

to prevent the proportion of deaths fromSmall Pox in London from diminishingso rapidly as would otherwise havebeen the case, and as has been the case,since this unaccountable infatuation,as Sir Gilbert Blane very justly calls it,has been discontinued. But, as the sameeminent physician properly remarks (p.6), it was in the rural population thatthe effect of inoculation in diffusingSmall Pox was chiefly felt. In thissituation, there is much less intercourseof persons with each other than intowns, so that not only many individualsescaped, from their not being exposedto infection during their whole lives, butwhole districts were known to havebeen exempt from it for a long series of

years before it was universally diffusedby inoculation. We may, thereforeconclude, that while the number ofdeaths from Small Pox, within the billsof mortality, was increased in theproportion exhibited in the tables bymeans of inoculation, in the country theincreased mortality from this cause wasin a much greater ratio. This suppositionis in a great degree confirmed by theeffects occasioned by a renewal of thepractice of inoculation, in Norfolk, inthe year 1819, as recorded by Mr.Cross, in his History of the EpidemicSmall Pox, which at that time prevailedin the city of Norwich and the county ofNorfolk. Mr. Cross mentions manyinstances of the disease being

introduced into parishes, in which it didnot before exist, by means ofinoculation, the contagion afterwardsspreading in all directions; and affirms(p. 272), that thirty-eight surgeons,who from various motives, practised it,lost among those to whom they had thusgiven the disease, twenty-one patients;fourteen surgeons reported, that fifty-five deaths had been occasioned in thesame way within their knowledge; andfive other surgeons observed, that theyhad known several who fell a sacrificeto the practice. It admits then of themost incontestable proof, and it is afact, which cannot be too deeplyimpressed upon the minds of the public,that inoculation for Small Pox is a

practice attended with veryconsiderable danger to the individualwho passes through it, while to societyin general, it has been productive of themost pernicious consequences. Is it toomuch then to affirm, that it cannot beemployed without great moral guiltbeing incurred both by those who mayrequire its performance, and by themedical practitioner who shall beinduced to practise it?But by far the most important mode inwhich Vaccination has been productiveof the equally astonishing and gratifyingconsequences, which have been provedto have resulted from it, has been by itsessential interference with the effect ofthe infectious matter of Small Pox,

either by entirely preventing theoccurrence of that disease, or bystripping it of all its dangerous andformidable characteristicsrenderingit, in the comparatively few instances inwhich it has taken place at all afterVaccination, mild in its attack, andperfectly harmless in its consequences.It very generally happens, when adiscovery is made which promises toexert any considerable influence overthe happiness of man, that itscapabilities cannot for some time bevery accurately defined; and that theeffects, which a few years experienceshall prove it to possess the power ofproducing, will, at the commencement,be either undervalued or overrated. It

would not, perhaps, be difficult toadduce instances of both. And it canscarcely excite surprise, that somethinglike this should have been the case withincomparably the most importantdiscovery of modern times, for such wemay truly esteem Vaccination, whetherwe consider it as a means of preservinglife, or of obviating effects, perhaps,even more deplorable than the loss oflife itself.If then, the first promoters ofVaccination were led, from their ardourin a cause of such vital interest to thewhole human race, and before time hadbeen allowed to afford sufficient datawhereon to found a more correctopinion, to conclude that Vaccination

would, in every instance, prove anabsolute and infallible preventive offuture susceptibility of Small Poxinfection, let us not, on that account, runinto an error incalculably moredangerous in its tendency, and underrateor deny altogether the degree of securitywhich it actually affords. That this ismore than sufficient to render it worthyof universal adoption, there cannot beany reasonable doubt; but it would havebeen strange indeed, if, in theundeviating uniformity of its effects,Vaccination had formed a singleexception to the law of uncertainty thatattaches to every other agent, which ithas, at any time, been permitted tomankind to employ for the promotion or

preservation of the health of the humanconstitution: and, considering theinnumerable varieties which prevail inthe latter, we ought rather, perhaps, tofeel surprise that the influence ofVaccination over all these varieties,should have been proved to be sosimilar as to have justified us inconsidering as a general, what was atfirst too hastily concluded to be anabsolute rule.That the great majority of instances inwhich Vaccination has afforded perfectsecurity against any future attack ofSmall Pox, fully warrants thisconclusion, the results already detailedare sufficient to prove. What proportionthese cases bear to the comparatively

few, wherein the protection has beenless perfect, it will not be possible todiscover, because we are unable toascertain how many hundreds ofthousands or millions have passedthrough the vaccinating process. Butlittle difficulty would be encountered,however, in ascertaining the full amountof the few who have had any thingbearing the slightest resemblance to anattack of Small Pox after Vaccination:these, for the most part, have beencarefully recorded, and a degree ofimportance has certainly been attachedto them greater than is warranted, eitherby their number, their severity, or theirresults.It is of still more importance, however,

to know, that when Small Pox hasoccurred after Vaccination, it has beenso essentially altered in the severity ofits symptoms, and in the degree ofdanger arising from it, as to haverendered it entirely harmless in almostevery instance; and although fatal caseshave taken place in a few insulated andpeculiar examples, they have been verymuch more rare than those which haveoccurred in consequence of inoculated,or even of secondary Small Pox. SirGilbert Blane, after describing (p. 10-11) the mild character of the disease asoccurring after Vaccination, continuesthusWhat forms the strong line ofdistinction from proper Small Pox is,that, with a few exceptions, it does not

advance to maturation and secondaryfever, which is the only period ofdanger. I am not prepared to deny thatdeath may have occurred in a fewinstances; nay, there seems sufficientevidence that it actually has; but thenadverse cases are so rare as not to formthe shadow of an objection to theexpediency of the general practice. Afew weeks ago, at a meeting of this (theMedical and Chirurgical) Society, atwhich forty members and visitors werepresent, I put the question, whether anyof these eminent and extensivepractitioners had met with any fatalcases of this kind. Two gentlemen hadeach seen a single case, and two othergentlemen took occasion to say, that they

had each seen a case of second SmallPoxboth of which proved fatal. AndDr. Thomson tells us (Historical Sketch,&c. p. 279), that since the publicationof my Account of the VarioloidEpidemic, I have seen above twohundred additional examples of SmallPox in Edinburgh, making in all eighthundred and thirty-six cases of thisdisease, which have come under myobservation since June, 1818. Of thewhole number, two hundred and eighty-one have occurred in individuals whohad neither had Small Pox nor CowPox, and of these fully more than one infour died; seventy-one had previouslypassed through Small Pox, and of thesetwo have died; and four hundred and

eighty-four had undergone the processof Vaccination, and of this number oneonly died; results (adds Dr. Thomson)which evince, beyond the power ofcavil, the beneficial effects ofVaccination in protecting the humanconstitution from the dangers of SmallPox, and the great advantages whichmust ultimately arise from the universaladoption of this practice.Perhaps themost fatal epidemic Small Pox, whichhas occurred of late years, was thatwhich took place at Norwich in 1819. Ahistory of it was published in thefollowing year by Mr. Cross, and thegeneral result was in perfectaccordance with Dr. Thomsonsexperience of the epidemic at

Edinburgh.Mr. Cross relates that two deaths onlytook place after Vaccination, and justlyobserves, that these can have noweight against the practice ofVaccination compared with 10,000vaccinated individuals, living in themidst of a contaminated atmosphere;with 530 deaths among little more than3000 who had neglected to bevaccinated; and with the occasionaloccurrence of regular Small Pox inthose who formerly had the disease. Ofthe 10,000 persons thus protected byVaccination, the Reviewer of Mr.Crosss History, &c. observes (Edin.Med. and Sur. Journal, Vol. xvii. p.127), Had these persons been

protected by variolous (Small Pox)inoculation, conducted in the bestmanner, and in the most favourablecircumstances, at least 33 of them (1 in300) would have died of the processintended to protect them; so that incomparing the advantages of the twomethods of protection, we have toweigh 33 deaths certain, against twocontingent on the invasion of anepidemic Small Pox, and then we haveto consider, whether there might not benearly as great a chance of two personsout of 10,000 inoculated for Small Pox,taking a fatal Small Pox on exposure, ata subsequent period of life, to a virulentcontagion. I shall conclude theevidence I think it necessary to bring

forward on this part of my subject withthe following extract from the Report ofthe National Vaccine Establishment for1820. In reference to the occasionalcases wherein the protection fromVaccination is not quite complete, theBoard observes,Yet the value of thisimportant resource is not disparaged inour judgment; for after all, these casesbear a very small proportion to thenumber of those who are effectuallyprotected by it. The reports of theVaccinators at the several stations in themetropolis, give only eight cases ofSmall Pox out of nearly 67,000vaccinated by them, since the firstestablishment of this board; and as theSmall Pox has prevailed extensively in

London, these persons so vaccinated,must have been frequently exposed tocontagion, and consequently theprotecting effect of Vaccination musthave been submitted to as severe a testas can well be imagined. Moreover, wehave the most undoubted proofs fromexperience, that where Vaccination hasbeen performed perfectly, Small Pox,occurring after it, is almost universallya safe disease; and though ushered in bysevere symptoms, has hardly ever failedto be cut short before it had reached thatperiod at which it becomes dangerousto life.I shall not weaken the force of thisevidence by entering into any minorquestion connected with this great

subjectsuch as the probability ofmany of those, in whom Small Pox hassucceeded to Vaccination, havingpassed through the latter processimperfectly, either in consequence of thematter employed not having beengenuine; of the constitution not havingshown adequate signs of being properlyinfluenced by the process; or of thelatter having been interfered with in itsprogress, by the accidental injury of thepustules, &c. No doubt all these causesmay have had some effect, inconsequence of the carelessness ofparents, or of the practice of non-professional inoculators: in a matter ofso much importance then, it behovesparents to guard against these causes of

failure, which it is now certainly withinthe power of the poorest to do. Norshall I detail the arguments by whichProfessor Thomson has rendered itprobable that the pustular eruption,which has been so long known in thiscountry under the name of Chicken Pox,is very nearly related to Small Poxitself, and is in reality the effect of thesame infectious virus modified byvarious incidental circumstances; suchas season of the year, the previousexistence of Small Pox or of Cow Poxin those affected by it, or somepeculiarity in their constitution notsufficiently obvious to be recognised byour senses. When I rest my proof of thepower of Vaccination over the

destructive consequences of Small Poxon the results which have been detailed,I am satisfied that it is fixed upon abasis too firm to be shaken by argument,and which will long outlive the feebleattacks of ignorance or prejudice.

CONCLUSION.

The following are the importantconclusions which may obviously bededuced from the satisfactory evidencewhich has been detailed.1. That Vaccination has, within thespace of twenty-five years, been thedirect means of preserving, within theLondon[8] Bills of Mortality alone, anumber of lives amounting to 21,127;and that if we extend the ratio ofcalculation to the whole of GreatBritain and Ireland, it will appear thatnot fewer than 393,356 lives have beensaved by this most valuable discovery,

while an equal number have beenpreserved from blindness, deformity,scrofula, or broken constitutions.

8. The following is extracted fromthe London Medical and PhysicalJournal for the present month(December):Influence ofVaccination upon the mortalityof Berlin. M. Casper haspublished a long paper,containing many curious detailsrelative to the above subject; butwe can do no more, at present,than give the result of hisinvestigations. 1. The Small Poxformerly carried off from the 12th

to the 10th of the population. 2.Formerly, at Berlin, one out oftwelve children born, died of theSmall Pox; now the deaths fromthe same cause are 1 in116.Journal Comp.September. In London, as hasbeen already shown, the numberof deaths from Small Pox hasbeen diminished from 1 in 10 to 1in 28. It is obvious, therefore,that, were Vaccination employedin the latter city to the sameproportional extent as at Berlin, afurther saving of more than 500lives annually would be effected,within the bills of mortality.

2. That in accomplishing this result,Vaccination has acted in two ways,1.by superseding the practice ofinoculation for Small Pox, which (whileit afforded a certain degree of securityto the inoculated) has been proved tohave materially increased the grossnumber of deaths, by creating,artificially, many new sources ofinfection,and, 2. by rendering thevaccinated entirely insusceptible ofSmall Pox infection, or the diseaseproduced by it, in almost everyinstance, mild, harmless, and devoid ofdanger.3. That Vaccination is capable, ifuniversally employed, of exterminatingthe Small Pox altogether, as has been

proved by the experience of othercountries.That Vaccination is a process perfectlyunattended with danger to the individualwho passes through it, and incapable ofcommunicating any noxious infection tothose around him, are facts too wellknown and too generally admitted, torequire more than a passing notice;nevertheless it is essential that theyshould not be lost sight of.But if these be indeed plain andlegitimate conclusions from the factsand arguments which have beenadducedand to myself they appearirresistible onesthen must Vaccinationcease to be considered as a matter of

policy, or of curious medical researchonly, for it plainly resolves itself into amomentous moral question. Let it oncebe admitted that it is capable oferadicating so great an evil as theinfection of Small Pox, and it becomesthe imperative duty of every individualto promote, to the utmost of his ability,an end so infinitely desirable. Thequestion involves consequences soclosely connected with the well-beingof individuals and of society in general,and the actual existence of so manythousands annually, that ignorance, ordoubt, will scarcely form an admissibleapology for the omission of what isalike essential for private and for publicsecurity. If then any be ignorant on this

momentous subject, let him not delay toobtain information; if any doubt, let himuse every exertion to satisfy himself. Ifhe hesitate to confer on his children theadvantages, which Vaccination has beenproved to be capable of bestowing, lethim remember, that it has already beenthe means of preserving nearly fourhundred thousand of his countrymen,and that, perhaps, he owes his ownexistence at this day, to its salutaryinfluence; that but for Vaccination hemight possibly himself, long ago, havefallen a sacrifice to the destructivedisease from which it has rescued somany victims, and have been equallyunable to call its efficacy in question, orto assist in consummating the grand

object, which by means of it alone,appears capable of being accomplished.It was in our own country, that this mostremarkable discovery originated; it wasour own countryman, who, with suchnoble disinterestedness, as soon as hehad satisfied himself of its real value,disclosed it to the world, and whosacrificed every personal considerationof pecuniary gain, to the general welfareof mankind. As Englishmen, we havejust cause to be proud of boththediscovery and the discoverer; but wemay well feel humbled when weremember, that the merits of neitherhave been adequately acknowledgedamongst us; and that while the latter hasbeen more justly estimated and more

highly honoured in almost every otherpart of the world, the former has alsobeen more effectively employed, andwith proportionally more decisiveresults.It is true, that in some of the continentalnations, where Vaccination has beenmost extensively and successfullyemployed, it has been made a matter ofstate policy, and legislative measureshave been used to enforce its adoption;while, at home, it has rested with thepublic to adopt or reject it, as might beagreeable to their opinions orprejudices. Some writers haveproposed that a similar mode ofenforcing its general employment inEngland, by legislative compulsion,

should be made use of; but, I conceive,such measures would be too little inaccordance with the spirit of ourgovernment, and too repulsive to thefeelings of Englishmen, to render themadvisable, notwithstanding theparamount national importance of theobject. That the time will presentlyarrive when this object will be fullyaccomplished, without any suchunpalatable interference of thelegislature, but by the irresistible forceof truth alone, on the minds of thepublic, I cannot permit myself to doubt.Means of information on the subject,ample and satisfactory, are within thereach of all who are anxious to enquire;and it cannot be that they should long

remain unexplored, or that they will failto carry conviction to the mind of everycandid and intelligent enquirer. But,when I reflect that the early convictionof a single individual, who entertains adoubt of the protective efficacy ofVaccination, or a prejudice against thepractice, may be the direct or indirectmeans of saving the lives of many, Icannot refrain from most earnestlyexhorting every one to consider thissubject maturelyto be strenuous andunremitting in his enquiries respectingit, until every doubt is satisfied. He willthen see one straight forward path ofduty before him, which he will feelhimself compelled, by every moral andreligious obligation, most perseveringly

and undeviatingly, to pursue. He willfeel that his own personal exertions, inpromoting the general use ofVaccination in his own family, amongsthis dependents and all those whom hecan in any the slightest degree influence,are essential to the accomplishment ofthe great philanthropic end proposedthe total extinction of Small Pox: aconsummation that would prevent alarger portion of human misery, andpreserve a larger number of humanlives, than any other which it is in thepower of imagination to conceive, or ofreason to contemplate.

TABLE I.

The first column of this Table exhibitsthe total number of deaths, and thesecond column the number ofdeaths from Small Pox, occurringwithin the London Bills ofMortality, during every successiveyear, for a period of 121 years.

Year.

Totalnumber

ofdeaths.

Numberof

deathsfromSmall

Pox.1703 20,720 8981704 22,684 1,5011705 22,097 1,0951706 19,847 7211707 21,600 1,0781708 21,291 1,6871709 21,800 1,0241710 24,620 3,1381711 19,833 9151712 21,198 1,9431713 21,057 1,6141714 26,569 2,8101715 22,232 1,0571716 24,436 2,4271717 23,446 2,211

1718 26,523 1,884

1719 28,347 3,2291720 25,454 1,4401721 26,142 2,3751722 25,750 2,1671723 29,197 3,2711724 25,952 1,2271725 25,523 3,1881726 29,647 1,5691727 28,418 2,3701728 27,810 2,1051729 29,722 2,8491730 26,761 1,9141731 25,262 2,6401732 23,358 1,1971733 29,233 1,370

1734 26,062 2,6881735 23,538 1,594

1736 27,581 3,0141737 27,823 2,0841738 25,825 1,5901739 25,432 1,6191740 30,811 2,7251741 32,169 1,9771742 27,483 1,4291743 25,200 2,0291744 20,606 1,6391745 21,296 1,2061746 28,151 3,2361747 25,494 1,3801748 23,869 1,7891749 25,516 2,625

1750 23,727 1,2291751 21,028 9981752 20,485 3,5381753 19,276 7741754 22,696 2,3591755 21,917 1,9881756 20,872 1,6081757 21,313 3,2961758 17,576 1,2731759 19,604 2,5961760 19,830 2,1871761 21,083 1,5251762 26,326 2,7431763 26,143 3,5821764 23,202 2,3821765 23,230 2,498

1766 23,911 2,3341767 22,612 2,1881768 23,639 3,028

1769 21,847 1,9681770 22,434 1,9861771 21,780 1,6601772 26,053 3,9921773 21,656 1,0391774 20,884 2,4791775 20,514 2,6691776 19,048 1,7281777 23,334 2,5671778 20,399 1,4251779 20,420 2,4931780 20,517 8711781 20,709 3,500

1782 17,918 6361783 19,020 1,5501784 17,828 1,7591785 18,919 1,9991786 20,454 1,2101787 19,349 2,4181788 19,697 1,1011789 20,749 2,0771790 18,038 1,6171791 18,760 1,7471792 20,213 1,5681793 21,749 2,3821794 19,241 1,9131795 21,179 1,0401796 18,905 3,5481797 17,014 522

1798 18,155 2,2371799 18,134 1,1111800 23,068 2,4091801 19,374 1,461

1802 19,379 1,5791803 19,582 1,2021804 17,038 6211805 17,565 1,6851806 17,938 1,1581807 18,334 1,2971808 19,954 1,1691809 16,680 1,1631810 19,893 1,1981811 17,043 7511812 18,295 1,2871813 17,322 898

1814 19,783 6381815 19,560 7251816 20,316 6531817 19,968 1,0511818 19,705 4211819 19,228 7121820 19,348 7921821 18,451 5081822 18,863 6041823 20,587 774

TABLE II.

This Table is divided into intervals offive years each. It embraces thesame period of 121 years, includedin the former, and is intended toshew the encrease in the averageamount of mortality from Small Poxduring the practice of Inoculation,and the striking diminution whichhas taken place since theintroduction of Vaccination.

Number

Periodsof 5 yearsincluding

Totalnumber

ofdeaths.

ofdeathsfromSmallPox.

1703 to1707 106,948 5,293

1708 --1712 108,742 8,707

1713 --1717 117,740 10,119

1718 --1722 132,216 11,095

1723 --1727 138,737 11,625

1728 -- 132,913 10,705

17321733 --1737 134,237 10,750

1738 --1742 141,720 9,415

1743 --1747 120,753 9,484

1748 --1752 114,625 10,179

1753 --1757 106,074 10,025

1758singleyear

17,576 1,273

1759 --1763 112,986 12,633

1764 --1768

116,594 13,630

1769 --1773

113,770 10,645

1774 --1778 104,179 10,808

1779 --1783 98,584 9,050

1784 --1788 96,247 8,487

1789 --1793 99,509 9,391

1794 --1798 94,494 9,260

1799 --1803 99,537 7,762

1804 --

1808 90,829 5,930

1809 --1813 89,233 5,299

1814 --1818 99,332 3,488

1819 --1823 96,477 3,390

The first Bracket includes the periodwhen Inoculation for Small Pox was inmost general use. The second Bracketthe period of Vaccination.

Lately was published by the sameAuthor, and to be had ofE. Charnley, Price 1s.

HINTS

TOWARDS THE ADOPTION OF AN

IMPROVED PRINCIPLE OFREMUNERATING

The Surgeon Apothecary,

OR,

GENERAL PRACTITIONER INMEDICINE.

ADDRESSED TO THE

MEMBERS OF THE PROFESSION

AND THE

PUBLIC AT LARGE.

Newcastle; Printed by T. & J.Hodgson,

Union Street

Transcribers note:

Page 4, in-instances changed toinstances, where three instanceshad occurredPage 14, recal changed to recall,who cannot recall many morePage 24, double quote moved to afteradvantages, of some realadvantages (p. 59).Page 25, double quote inserted afterare, words are (p. 37),Page 59, double quotes added afterresults and before which, results(adds Dr. Thomson) which evincePage 73, full stop inserted after table

heading Year.Page 74, 8817 changed to 1788,1788 19,697 1,101

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