A Statement of Facts Tending to Establish an Estimate of the True Value and Present State of Vaccination

Part 1

STATEMENT OF FACTS,

TENDING TO

ESTABLISH AN ESTIMATE OF THE TRUE VALUE

AND

PRESENT STATE

VACCINATION.

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BY SIR GILBERT BLANE, BART.

F.R.S. of London, Edinburgh, and Göttingen; Member of the Imperial Academy of St. Petersburgh; and Physician in Ordinary to the King.

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FROM THE TENTH VOLUME OF THE MEDICO-CHIRURGICAL TRANSACTIONS, PUBLISHED BY THE MEDICAL AND CHIRURGICAL SOCIETY OF LONDON;

WITH ADDITIONS.

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LONDON:

PRINTED FOR THOMAS AND GEORGE UNDERWOOD, 32, FLEET STREET.

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1820.

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J. MOYES, GREVILLE STREET, LONDON.

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STATEMENT OF FACTS,

TENDING TO ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND PRESENT STATE OF

VACCINATION.

BY SIR GILBERT BLANE, BART. F.R.S. Lond. &c.

Physician in Ordinary to the King.

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Read Nov. 10, 1819.

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Part 2

It is now twenty-one years since Vaccination was promulgated in this country by Dr. Jenner, and fifteen years since it began to produce a sensible effect in diminishing the mortality from Small Pox. In regard to the latter period, it is coeval with this Society; yet, though no discovery in nature nor in medicine has been more important to the interests of humanity, nor any which has ever so rapidly and universally won the assent and practical adoption of mankind, there are no notices of it on our records, except in our second volume, in an article by Dr. Bateman, in which he relates a case of a mother who was affected with the Small Pox a second time, by being exposed to infection, from some of her own children who had caught it casually; while her other children, who had been vaccinated, resisted it. As it is to be hoped that our labours will prove to posterity some of the principal sources of reference regarding the medical and chirurgical discoveries and improvements of the age; as it is one of the reproaches of our country, that it has not availed itself so much as any other of the benefits of Vaccination; and as there are writers among us who still allege that the failures are so numerous that the value of the discovery is very ambiguous, it seems one of the duties of the Society to lend its aid in placing these important points in their true light.

It seems almost needless to premise, that the Small Pox is of all maladies that, which, during the last thousand years, has destroyed the largest portion of the human species, and been productive of the largest share of human misery. There is, perhaps, no disease over which medical art has less power; and this power, such as it is, has consisted more in abolishing pernicious practices, than in ascertaining any positive methods of controlling its fatality, unless we except the inoculation of it with its own virus. But, though the beneficial effect of this on those on whom it is actually practised is undeniable, it has no tendency like Vaccination to extirpate the disease; and from the impossibility of rendering it universal, it has actually been found to add to the general mortality of Small Pox, by opening a new source for the diffusion of its virus.

It ought to be stated also, with a view to a decision on this question, that Vaccination itself is attended with no danger, and frequently takes effect without any visible disturbance in the system. There is even reason to believe, that in its process it wards off other diseases, by pre-occupying the constitution.

In order to bring this matter to the test of calculation, in order also to institute a comparison of the mortality of Small Pox as influenced by Vaccination, as well as by Inoculation from itself, I have selected from the bills of mortality four periods, each of fifteen years, for the purpose of exhibiting the mortality of Small Pox in each of these series in regard to each other. These are thrown into the form of Tables, and annexed to this article.

The first series, is the fifteen years immediately preceding the introduction of Inoculation; that is, from 1706 to 1720, both included. Previous to this period, no account that could be depended upon regarding the Small Pox, could be derived from the bills of mortality; for down to the beginning of last century such was their imperfect construction, that Small Pox, Measles, and Flux were blended under one head. Exception may be taken against the accuracy of these bills, even in this improved state, particularly with regard to the discrimination of diseases. This objection, however, is certainly less applicable to Small Pox than any other disorder, its character being so striking as not to be mistaken by the most ignorant and careless observer.

The second series is taken at the middle of the last century, when Inoculation had made considerable progress; that is, from 1745 to 1759, both included. In comparing this with the preceding series, with regard to absolute numbers, it ought to be taken into account, that eleven parishes were added to the bills of mortality, between the years 1726 and 1745, both included: so that the progressive improvement of general salubrity ought to be estimated still higher than what is indicated by the diminished mortality, as it stands in the Tables.

The third series comprises the fifteen years previous to the introduction of Vaccination, when Inoculation had made still greater progress; that is, from 1785 to 1798, both included.

The fourth series comprises the time in which the vaccine Inoculation has been so far diffused as to produce a notable effect on the mortality of Small Pox; that is, from 1804 to 1818, both included.

The result of these computations stands as follows:—

Ratio of the Mortality of Small Pox to the total Mortality.

From 1706 to 1720, one in 12.7; that is, 78 in 1000. From 1745 to 1759, one in 11.2; that is, 89 in 1000. From 1785 to 1798, one in 10.6; that is, 94 in 1000. From 1804 to 1818, one in 18.9; that is, 53 in 1000.

Fractions are not noticed in the last column of numbers.

It appears from this statement, that the proportion of deaths from Small Pox to the total mortality, increased in the course of last century; so that Inoculation appears to have added to the mortality. It is but fair to mention, however, that this total mortality is not quite a just scale whereby to measure the relative mortality of Small Pox; for in the course of that century, the general mortality itself was greatly diminished in relation to the population. This diminution of general mortality was chiefly owing to the diminished mortality of children under two years of age, which, at the time when the account began to be kept, 1729, averaged about 9000; but at the end of the century not more than 5000; also to the decrease of fevers, and still more of fluxes. The relation of the mortality of Small Pox to the population, would therefore be a more fair criterion of its increase or decrease. In this view it might, at first sight, be thought that it had decreased; for the population of the metropolis nearly doubled in the course of the last century. But it is to be remarked, that there has been little increase of population in that portion of the metropolis which is included in the bills of mortality; the great increase having been in the parishes of Mary-le-bone and St. Pancras, which are not included in these bills. It is computed in the remarks subjoined to the last parliamentary returns of population, that the population of London, within the walls, had decreased more than three-fifths in the course of last century, from the widening of streets, the erection of public buildings and warehouses, and, it might have been added, from the migration of mercantile families to the west end of the town. As a set-off to this, there has certainly been a great addition, in the same time, to those parishes within the bills, which stand on the verge of the metropolis, such as St. George’s Hanover Square, St. George’s Bloomsbury, Poplar, and Stepney. But the addition to the population, if any, within the bills of mortality, does not seem to be so considerable as to affect the computation. And, if this is admitted, the absolute numbers of the deaths from Small Pox, estimated in relation to the population, that is, exactly as they stand on the Tables, afford a fair comparative statement of the mortality in the last century, and seem to prove that Inoculation has not added so much to it as has been alleged. It was in the rural population that the effect of Inoculation in diffusing Small Pox was chiefly felt. In this situation there is much less intercourse of persons with each other than in towns, so that not only many individuals escaped from their not being exposed to infection during their whole lives, but whole districts were known to have been exempt from it for a long series of years, before it was universally diffused by Inoculation.

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