Part 3

The description of those cases of Small Pox, (if they can be called so,) which occur in vaccinated subjects, is shortly as follows:—The invasion and eruption in every respect resembles that of the genuine Small Pox. I have seen it attended with high fever and a thick crowded crop of papulæ, such as precedes the most severe and dangerous cases of the confluent kind. This runs on till the fifth day from the eruption, both days included, at which time some of the papulæ begin to be converted into small sized pustules. The disorder then abruptly stops short. On the following day the fever is found to have subsided, with a shrivelling and desiccation of the eruption, and recovery proceeds without the least danger or inconvenience. The face is marked, for some time after, with brown spots, but without pits. It should never be forgotten, that all morbid phænomena are full of varieties and exceptions. Accordingly, though the fifth day is the most common limit of this disorder, it sometimes stops short on the third; sometimes not till the sixth or seventh; and, in a very few cases, it has been known to run the common course of Small Pox. What forms the strong line of distinction from proper Small Pox, is that, with a few exceptions, it does not advance to maturation and secondary fever, which is the only period of danger. I am not prepared to deny that death may not have occurred in a few instances; nay, there seems sufficient evidence that it actually has; but these adverse cases are so rare, as not to form the shadow of an objection to the expediency of the general practice. A few weeks ago at a meeting of this Society, at which forty members and visitors were present, I put the question whether any of these eminent and extensive practitioners had met with any fatal cases of this kind. Two gentlemen had each seen a single case, and two other gentlemen took occasion to say that they had each seen a case of second Small Pox, both of which proved fatal. It is evident, therefore, that according to that maxim which guides mankind in the conduct of life, namely, that of acting on a general rule and average, and not on exceptions, these adverse instances ought not to have the least influence on practice, even though they were much more numerous. Nor indeed do they, except in the very rare cases here cited, deserve the name of failures; for, though they fail in preventing Small Pox, they do not fail to prevent Death. And let me here, in the name of humanity, beseech practitioners not to be forward in publishing single cases of failures, real or supposed; for, when the weak minded and uninformed hear of these failures, without hearing at the same time that there are hundreds of cases of permanent security for every single case of failure, they are guided by the exception, which becomes to them the rule; their judgments being thereby most fatally perverted.

As it is of the utmost consequence to establish the strong and important distinction between Small Pox, properly so called, and that which takes place after Vaccination, which may be called the mitigated, or five day Small Pox, a few of the most impressive testimonies respecting the safe nature of the latter may be here recited. Mr. Brown, of Musselburgh, gives the detail of forty-eight cases, in none of which did the secondary fever nor death occur. Here was a saving of at least eight lives, at the lowest computation; for this is the number which, by the average mortality of natural Small Pox, would have died if the constitutions of these forty-eight persons had not been modified by previous Vaccination. Dr. Dewar, of Edinburgh, hearing that many vaccinated subjects had been affected with Small Pox at Cupar in Fife, where the natural Small Pox at the same time prevailed, he most laudably repaired to the spot to investigate the subject. He found that fifty-four vaccinated subjects had caught the Small Pox. All these, except one, had the mitigated or five day eruptive fever, and livid. The fatal case was that of a child, who had a complication of other disorders, and having died on the fifth day, the Small Pox, according to its ordinary course of fatality, could not of itself be the cause of death. All the rest were safe; while of sixteen cases of the natural Small Pox at the same time and place, six died; so that, if these fifty-three cases had not undergone the mitigating process of Vaccination, nineteen or twenty would have perished. Between thirty and forty cases of the same kind have occurred at Carlisle, on the testimony of Dr. Barnes, a respectable practitioner of that city. Many proofs might be adduced from the oral testimony of private practitioners, which would overswell this article. The only other to be mentioned is from the Report of the Central Committee of Vaccination at Paris, made in December last, in which the description of the disease occurring after Vaccination corresponds exactly with the mitigated five day cases which have occurred in Britain. They refuse the name of Small Pox to it; but as I know from my own observation, as well as from the testimony of others, that the matter from it does by Inoculation give the Small Pox, we can hardly, perhaps, with propriety deny it that name; but it should be distinguished by some strong discriminating epithet, such as is suggested above.

As the attack of Small Pox in subjects who have undergone Vaccination, generally occurs after a long interval, it becomes a question whether this is owing merely to the chance of such subjects not having been exposed to variolous contagion, or to the effect of time in diminishing the antivariolous virtue of vaccination. The former is certainly conceivable; but when we consider the numberless severe proofs to which the recently vaccinated were experimentally exposed in the early part of this practice all over Europe, from which the most satisfactory evidence resulted; and when it is considered that, in the great majority of cases, Small Pox has not occurred till several years after vaccination, it seems by far most probable that the virtue of it is weakened by time. When parents, therefore, become anxious and apprehensive regarding the risk of Small Pox after a lapse of years, it seems quite reasonable that they should be indulged in having the operation repeated.

Let all this be applied to the case of a community, in which the total eradication of Small Pox is quite hopeless. Let it be admitted that such occurrences as have been described do frequently occur: let it even be admitted, for argument’s sake, that every vaccinated case whatever must of necessity and unavoidably at some time or other in future life be affected with this mitigated species of Small Pox, would it not even under this great abatement be one of the greatest boons that could be conferred on humanity, being an instrument or remedy which would disarm Small Pox of its danger? Would not the next greatest benefit to the total extirpation of Small Pox, be the stripping it of its terrors by rendering it safe and harmless?

It may be further remarked, that the benefit derivable from the different proportions of the persons vaccinated to the total population, advances in a considerably higher progression than the simple arithmetical. It is evident that the smaller the relative number of the vaccinated, the greater their chance of meeting with Small Pox infection, and that though the disease which they may catch is of a mitigated nature, it would nevertheless be desirable to avoid it on its own account, but still more on account of the prejudice it creates. This, in the eye of general benevolence, constitutes an additional, though secondary motive for extending the vaccine inoculation as widely as possible, even though the attainment of the maximum, that is, total extirpation, should be impracticable and hopeless.

It is of the highest importance to society, that this subject should be seen in its true light, and in all its bearings; for the frequent occurrence of these cases of Small Pox, however safe in themselves, have had a most pernicious effect on the credulous and ignorant, by giving a check to the practice of Vaccination. It ought never to be forgot that the power of Vaccination in extirpating Small Pox being established, the question of its expediency is completely set at rest. How many parents are there now who, from a weak distrust in the virtue of Vaccination, have to lament the loss of a child from Small Pox, either casual or inoculated? Many such are known to myself. It is pleasing, however, to observe, that though this unmerited discredit into which Vaccination had fallen, swelled the number of deaths in London from Small Pox to 1051 in 1817, good sense is likely still to prevail, for last year (1818) the deaths have fallen lower than they have ever been known since the institution of the bills of mortality, the total number being only 421.

On the whole matter, I believe I am speaking the language of every man of good principles and feelings, capable of reflecting seriously and considerately on the subject, when I say, that whenever he applies his mind to it, he finds some new and increasing cause of complacency and satisfaction. Viewed as a mere physical fact in the natural history of the animal kingdom, the virtue of the vaccine virus in resisting the action of the variolous, is, by its novelty and singularity, highly striking and interesting to every one whose taste leads him to take delight in contemplating and exploring the devious ways and varied forms of Nature, as curious exceptions to the uniformity and constancy of her laws. One can hardly contemplate with sufficient astonishment, the extraordinary fact that a morbid poison taken from a domestic animal should, when inserted into the human body, shield it against the assault of one of the most fatal and cruel maladies to which it is incident. But the importance of this, as a physical curiosity, vanishes to nothing when the unexampled benefits of it to mankind are fairly weighed; benefits which could never have been dreamt of by the most sanguine philanthropist, who, in contemplating it, finds himself lost in astonishment, at a boon to mankind almost beyond the grasp of his mind duly to appreciate: so that what seems at first sight merely a sportive aberration from the usual course of things, has, by the wise dispensation of Providence, become subservient to the most beneficent purposes: and how many more useful discoveries may there yet be in reserve for the alleviation of human misery, from obscure and undetected facts still lurking under the very surface of Nature! It will in the eyes of future ages be deemed an epocha in the destinies of the world, and one of the highest boasts of the country in which it took its rise, with a sense of unrequitable obligation to the individual who first disclosed and promulgated the secret, by drawing it from the dark recesses of rural tradition, and rendering it available to the whole human race.

Such are the sentiments which must fill every well constituted mind; and it behoves the whole medical profession, which has already done itself so much honour by the zealous and disinterested encouragement afforded to it, to continue its efforts in eradicating every remaining prejudice against it. It becomes Englishmen, in particular, to cherish it, not only as the native offspring of their country, of which they have reason to be proud, but to redeem the character of the nation from the reproach of having, of all others, whether savage or civilized, done the least justice to this noble discovery. It is somewhat humiliating to reflect, that while there is no country which has received more striking and unambiguous benefits from this discovery, there is none which has prized it less, nor availed itself of it so little. I here allude to the unspeakable advantage of it to the public service, both by sea and land, in the late war, so eventful and portentous in its course, and so glorious in its termination. Formerly, Small Pox was one of the greatest embarrassments to the operations of armies; and ships of war were occasionally under the necessity of quitting the sea, from the prevalence of this disorder among their crews. Those lately at the head of the navy and army, with that vigilant wisdom and humanity which become those who direct the affairs of a great and enlightened nation, recommended and enforced the practice of Vaccination in both these departments, to the great furtherance of the public service. Their example has by no means been followed among the civil population of England. This is chiefly imputable to the abuse of the press, the general licentiousness of which may be denounced as one of the most grievous evils of this age and country, in regard to other subjects interesting to humanity and public happiness, as well as this; the votaries of error and depravity being more successful, because they find more encouragement in disseminating their principles, than the advocates of truth, virtue, and good order. There is no maxim more true, than that the best things do become by abuse the worst, and that in proportion to their excellence. What a mortifying contrast does England form with Peru, where it was adopted instantly, in consequence of a flash of conviction from the light of evidence! and was not this conviction fully justified by the immediate disappearance of Small Pox from that whole region? To those nations who may feel an envy of the glory attached to our country by this discovery, it must be no small consolation to perceive that a large proportion of the English nation has hitherto been so besotted as not to know how to appreciate it, nor how to avail themselves of it, and that it has encountered more opposition among ourselves than in all the world besides.

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TABLE I.

┌──────┬──────────┬──────────────┬───────────┬──────────┐ │Years.│ Total │Mortality from│Proportion.│Proportion│ │ │Mortality.│ Small Pox. │ │ to 1000. │ ├──────┼──────────┼──────────────┼───────────┼──────────┤ │ 1706 │ 22,097 │ 1094 │1 in 20 │ 50│ │ 1707 │ 21,600 │ 1078 │1 20 │ 50│ │ 1708 │ 21,291 │ 1687 │1 12-1/2│ 79│ │ 1709 │ 21,800 │ 1024 │1 21 │ 49│ │ 1710 │ 24,620 │ 3138 │1 8 │ 127│ │ 1711 │ 19,833 │ 915 │1 21-1/2│ 46│ │ 1712 │ 21,198 │ 1943 │1 11 │ 92│ │ 1713 │ 21,057 │ 1614 │1 13 │ 77│ │ 1714 │ 26,569 │ 2810 │1 9-1/2 │ 106│ │ 1715 │ 22,232 │ 1057 │1 21 │ 47│ │ 1716 │ 24,436 │ 2427 │1 10 │ 100│ │ 1717 │ 23,446 │ 2211 │1 10-1/2│ 94│ │ 1718 │ 26,523 │ 1884 │1 14 │ 71│ │ 1719 │ 28,347 │ 3229 │1 8-3/4 │ 114│ │ 1720 │ 25,454 │ 1440 │1 17-1/2│ 56│ ├──────┴──────────┼──────────────┼───────────┼──────────┤ │ Total—350,503 │ 27,557 │1 12.7 │ 78│ └─────────────────┴──────────────┴───────────┴──────────┘

In this series it appears that the deaths from Small Pox are, to the total mortality, as 1 in 12.7; that is, 78 in 1000.

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TABLE II.

┌──────┬──────────┬──────────────┬───────────┬──────────┐ │Years.│ Total │Mortality from│Proportion.│Proportion│ │ │Mortality.│ Small Pox. │ │ to 1000. │ ├──────┼──────────┼──────────────┼───────────┼──────────┤ │ 1745 │ 21,296 │ 1206 │1 in 17-3/4│ 56│ │ 1746 │ 28,157 │ 3236 │1 8-3/4 │ 115│ │ 1747 │ 25,494 │ 1380 │1 18-1/2│ 54│ │ 1748 │ 23,869 │ 1789 │1 13-1/2│ 75│ │ 1749 │ 25,516 │ 2625 │1 9-3/4 │ 103│ │ 1750 │ 23,727 │ 1229 │1 19-1/4│ 52│ │ 1751 │ 21,028 │ 998 │1 21 │ 48│ │ 1752 │ 20,485 │ 3538 │1 5-3/4 │ 172│ │ 1753 │ 19,276 │ 774 │1 25 │ 40│ │ 1754 │ 22,696 │ 2359 │1 9-1/2 │ 104│ │ 1755 │ 21,917 │ 1988 │1 11 │ 91│ │ 1756 │ 20,872 │ 1608 │1 13 │ 77│ │ 1757 │ 21,313 │ 3296 │1 6-1/2 │ 155│ │ 1758 │ 17,576 │ 1273 │1 13-3/4│ 73│ │ 1759 │ 19,604 │ 2596 │1 7-1/2 │ 132│ ├──────┴──────────┼──────────────┼───────────┼──────────┤ │ Total—332,826 │ 29,895 │1 11.2 │ 89│ └─────────────────┴──────────────┴───────────┴──────────┘

In this series it appears that the proportion of deaths from Small Pox is, to the total mortality, as 1 in 11.2; that is, 89 in 1000.

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TABLE III.

┌──────┬──────────┬──────────────┬───────────┬──────────┐ │Years.│ Total │Mortality from│Proportion.│Proportion│ │ │Mortality.│ Small Pox. │ │ to 1000. │ ├──────┼──────────┼──────────────┼───────────┼──────────┤ │ 1784 │ 20,454 │ 1210 │1 in 17 │ 59│ │ 1785 │ 18,919 │ 1999 │1 9-1/2 │ 106│ │ 1786 │ 20,445 │ 1210 │1 17 │ 59│ │ 1787 │ 19,349 │ 2418 │1 8 │ 125│ │ 1788 │ 19,697 │ 1101 │1 17-3/4│ 56│ │ 1789 │ 20,749 │ 2077 │1 10 │ 100│ │ 1790 │ 18,038 │ 1617 │1 11-1/4│ 89│ │ 1791 │ 18,760 │ 1747 │1 10-3/4│ 93│ │ 1792 │ 20,313 │ 1568 │1 13 │ 77│ │ 1793 │ 21,749 │ 2382 │1 9 │ 11│ │ 1794 │ 19,241 │ 1913 │1 10 │ 99│ │ 1795 │ 21,179 │ 1040 │1 20-1/4│ 49│ │ 1796 │ 19,288 │ 3548 │1 54 │ 18│ │ 1797 │ 17,014 │ 512 │1 33-1/2│ 30│ │ 1798 │ 18,155 │ 2237 │1 8 │ 123│ ├──────┴──────────┼──────────────┼───────────┼──────────┤ │ Total—293,350 │ 26,579 │1 11 │ 90.9│ └─────────────────┴──────────────┴───────────┴──────────┘

In this series it appears that the proportion of deaths from Small Pox to the total mortality is 1 in 11, that is, 90.9 in 1000.

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TABLE IV.

┌──────┬──────────┬──────────────┬───────────┬──────────┐ │Years.│ Total │Mortality from│Proportion.│Proportion│ │ │Mortality.│ Small Pox. │ │ to 1000. │ ├──────┼──────────┼──────────────┼───────────┼──────────┤ │ 1804 │ 17,038 │ 622 │1 in 27-1/2│ 36│ │ 1805 │ 17,565 │ 1685 │1 10-1/2│ 96│ │ 1806 │ 18,334 │ 1297 │1 14 │ 71│ │ 1807 │ 17,938 │ 1158 │1 15-1/2│ 65│ │ 1808 │ 19,964 │ 1169 │1 17-1/4│ 58│ │ 1809 │ 16,680 │ 1163 │1 14-1/4│ 70│ │ 1810 │ 19,893 │ 1198 │1 16-1/2│ 60│ │ 1811 │ 17,043 │ 751 │1 22-3/4│ 44│ │ 1812 │ 18,295 │ 1287 │1 14-1/4│ 70│ │ 1813 │ 17,322 │ 898 │1 19-1/4│ 52│ │ 1814 │ 19,783 │ 638 │1 31 │ 32│ │ 1815 │ 19,560 │ 725 │1 27 │ 37│ │ 1816 │ 20,316 │ 653 │1 31-1/4│ 32│ │ 1817 │ 19,968 │ 1051 │1 19 │ 53│ │ 1818 │ 19,705 │ 421 │1 47 │ 21│ ├──────┴──────────┼──────────────┼───────────┼──────────┤ │ Total—279,404 │ 14,716 │1 18.9 │ 53│ └─────────────────┴──────────────┴───────────┴──────────┘

In this series it appears that the proportion of deaths from Small Pox to the total mortality is 1 in 18.9, that is, 53 in 1000.

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LONDON:

PRINTED BY J. MOYES, GREVILLE STREET.

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