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.

But the truly important result from these statements consists in the clear, undeniable, and great diminution of it since the introduction of Vaccination. It appears, that in the last fifteen years, the mortality from Small Pox, in the bills of mortality, has not been much more than one-half of what it was in the two like series of years in the middle and latter end of the last century. Nor does this comprise the whole benefit derived from this discovery in the metropolis; for, besides that the sixth part of it lies without the bills, it was found, in levying the tax on burials for the last six months of 1794, that the number of unregistered deaths, chiefly those of dissenters, amounted in that half year to 3148; and the reporter of the parliamentary enumeration thinks that, as besides these there were undiscovered interments, the unregistered deaths may be computed at one-third of the total mortality, that is, about 7000. (See Abstract of the Parish Registers, 1811, printed by authority of Parliament, page 200.)

Assuming, therefore, that Vaccination had not been practised the last fifteen years, and that the mortality from Small Pox, within the bills, had in that time, that is, from 1804 to 1818, been the same as from 1784 to 1798, that is, 27,569 in place of 14,716; and assuming that there has been the same proportional diminution of deaths in the districts without the bills, and among the unregistered subjects, the account of lives saved in this metropolis by Vaccination in the fifteen years, will stand as follows:—

Within the bills of mortality 12,853 Without the bills of mortality 2,570 Unregistered cases 7,711 ------ Total 23,134

The first of these numbers is found by subtracting the amount of deaths by Small Pox, in the bills of mortality, during the practice of Vaccination, from the amount of them, during the same number of years, immediately before the discovery of Vaccination.

The second number is found by dividing the first by 5. The population of the metropolis without the bills is stated at one-sixth of the whole, which is evidently one-fifth of that within the bills.

The third number is found by dividing the sum of the two others by 2; the unregistered cases being, as before stated, one-third of the whole.

It appears, therefore, that, even under the very imperfect practice of Vaccination which has taken place in this metropolis, 23,134 lives have been saved in the last fifteen years, according to the best computation that the data afford. It will be seen, by an inspection of the Table, that in that time there have been great fluctuations in the number of deaths. This has been owing partly to the Small Pox Inoculation of out-patients having, by an unaccountable infatuation, been kept up at the Small Pox Hospital for several years after the virtue of Vaccination had been fully confirmed. The greater number of deaths in 1805 may chiefly be referred to this cause. Since the suppression of this practice, the adoption of Vaccination, though in a degree so incomplete, in consequence of public prejudice, created entirely by mischievous publications, has been unable to prevent a considerable, though fluctuating, mortality from Small Pox. The late mortality from Small Pox, though little more than one half of what it was in former times, might have been entirely saved, if Vaccination had been carried to the same extent as in many cities and whole districts on the continent of Europe, in Peru, and Ceylon.

In the summer of 1811 the author was called to visit, professionally, Don Francisco de Salazar, who had arrived a few days before in London, on his route from Lima to Cadiz, as a deputy to the Spanish Cortes. He informed him, that Vaccination had been practised with so much energy and success in Lima, that for the last twelve months there had occurred, not only no death from, but no case of, Small Pox; that the new-born children of all ranks are carried as regularly to the Vaccinating House as to the font of baptism; that the Small Pox is entirely extinguished all over Peru; nearly so in Chili; and that there has been no compulsory interference on the part of the government to promote Vaccination.

It is now matter of irrefragable historical evidence, that Vaccination possesses powers adequate to the great end proposed by its meritorious discoverer, in his first promulgation of it in 1798, namely, the total extirpation of Small Pox. The first proof of this was at Vienna, where, in 1804, no cases occurred, except two strangers who came into the city with the disease upon them. In 1805 there did not occur a single death from it in Copenhagen. Dr. Sacco, the indefatigable superintendent of Vaccination in Lombardy, stated, in his Annual Report, 3d January, 1808, that the Small Pox had entirely disappeared in all the large towns in that country; and that in the great city of Milan it had not appeared for several years. Dr. Odier, of Geneva, so favourably known for his high professional, scientific, and literary acquirements, testifies, that, after a vigorous perseverance in Vaccination for six years, the Small Pox had disappeared in that city and the whole surrounding district; and that, when casually introduced by strangers, it did not spread, the inhabitants not being susceptible. The Central Committee in Paris testify, in their Report of 1809, that the Small Pox had been extinguished at Lyons and other districts of France.

These are selected as some of the earliest and most remarkable proofs of the extirpating power. But it is demonstrable, that if at the first moment of this singular discovery, at any moment since, at the present or any future moment, mankind were sufficiently wise and decided to vaccinate the whole of the human species who have not gone through the Small Pox, from that moment would this most loathsome and afflicting of all the scourges of humanity be instantaneously, and for ever, banished from the earth.

It is farther manifest, that extirpation being the ultimate aim of this discovery, and there being the fullest historical and practical evidence of its being capable of accomplishing this end, all other questions with regard to its expediency must be futile and irrelevant. It is in the nature of all morbid phenomena to be liable to exception. One of the most essential and characteristic laws of Small Pox itself, namely, that of its affecting the human subject but once in life, is found in rare cases to be violated. It is, therefore, perfectly conformable to analogy, and naturally to be expected, that it may not in all cases be a complete security against Small Pox. But it is obvious, that, admitting these exceptions to be very frequent, much more so than the recurrence of Small Pox after Small Pox, this can constitute no objection to the practice, as long as the extirpating power remains unimpaired and unimpeached. Nay, it is obviously so far from an objection, that it ought to operate as a powerful additional incentive on every benevolent mind, to push Vaccination to the utmost, as rapidly as possible, in order that those who are still susceptible, either from peculiar natural constitution, or from the unskillful manner of conducting the operation, or from defective matter, may not, by any possibility, catch it; for, in the event of its extirpation, it could nowhere be met with. And in order to stimulate the good and the wise to aim strenuously at this consummation, let it be constantly borne in mind, that the adversary they are contending with is the greatest scourge that has ever afflicted humanity. That it is so, all history, civil and medical, proclaims: for, though the term Plague carries a sound of greater horror and dismay, we should probably be within the truth, if we were to assert, that Small Pox has destroyed a hundred for every one that has perished by the Plague.

It is true that in its last visitation of this metropolis, one hundred and fifty-four years ago, it carried off 70,000 victims in a few months; but since that time, the deaths from Small Pox, recorded in the bills of mortality, have amounted to more than 300,000; and a like number of the survivors have been afflicted with blindness, deformity, scrofula, or broken constitutions, which is not the case with the survivors of the Plague. It appears, by a Report of the Hospital for the Indigent Blind, that two thirds of those who apply for relief have lost their sight by the Small Pox. It is alleged by some of the soundest Political Economists that Small Pox does not diminish the numbers of mankind, nor Vaccination increase them; for population is determined by subsistence, and the indefinite powers of procreation soon repair the ravages of disease. But, however true this may be, the miseries incident to so many of those who survive Small Pox, whereby they become a burden to themselves, their families, and to society, render this disease uncontrovertibly an evil of the first magnitude, not to mention the intense sufferings and afflictions inseparable from it; and in this view of the matter the objection seriously adduced against Vaccination by one of its opponents, that Small Pox is a merciful dispensation of Providence for the poor man, by diminishing the burden of his family, will not hold good, for the burden is not removed.

And when it is considered that there are large portions of the globe, India, China, even one whole quarter of it (North and South America), besides all the tropical and arctic regions, in which the Plague has never been known; and that in all the countries liable to it, it seldom appears but at one season of the year, and in some at long intervals, the ravage which it makes is trifling when compared with the unceasing havoc of Small Pox, which spares no nation in any climate, or at any season. Yet the Legislative Regulations for excluding and checking the Plague are of the most harsh and despotic description, while the law touches upon Small Pox comparatively with the most lenient hand. It ought to be generally known, however, that in a late trial and conviction, it was laid down by the judge to be the law of the land, that a medical practitioner who neglects to exclude the person whom he inoculates from communication with others, is liable to fine and imprisonment. Morally considered, indeed, it is difficult to conceive a higher degree of flagitious turpitude than that of a professional person, in the present state of knowledge, exposing his fellow-creatures, from sordid motives, to one of the most grievous calamities of which human nature is susceptible.

The preceding reasoning is grounded on the supposition of extirpation: but, however demonstrable the possibility of extirpation may be, it may not in all communities be practicable; and may not these alleged failures so operate, as, in such circumstances, to render the expediency of the practice questionable?

In order to decide this, let the nature and amount of these failures be ascertained and estimated.