Part 2

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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 view—namely, 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.

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ESTIMATE,

&c. &c.

INTRODUCTION.

What reliance may safely be placed on Vaccination as a means of exemption from Small Pox?

It may be affirmed, without hazard of contradiction, that no question connected with the physical well being of mankind involves considerations of more serious interest, or consequences of more vital moment, than that which has just been proposed. During the last quarter of a century, it has engaged a degree of attention, both from medical practitioners and from society in general, proportionate to the great importance of the subject; and though among the former, with very few exceptions, one pretty uniform opinion may prevail respecting the true value of the Jennerian discovery, I have reason to know, that many doubts and apprehensions still linger in the minds of not a few of the latter. These have been cherished or revived by circumstances, of a nature, it must be admitted, well calculated to shake their confidence in Vaccination as an absolute preventive of Small Pox; which, unfortunately for the cause, on its first introduction into practice, it was generally believed and asserted to be; but which subsequent experience has proved can no longer be contended for. I trust, however, to be enabled to prove, to the satisfaction of every impartial enquirer, that the value of Vaccination is not essentially diminished on that account; that an imperfect knowledge of its effects can alone have given rise to the doubts and apprehensions referred to; and that nothing is required for their entire removal but a more intimate acquaintance with the subject. It is the purpose of the present Essay, then, to bring under review the principal facts connected with the history of Small Pox and of Vaccination which, in any way, bear upon the question proposed; to arrange them in such order, and to place them in such lights, as may best elucidate the subject, and enable those, who have children not yet protected in any way from the infection of Small Pox, to form a clear and satisfactory judgment; a judgment unbiassed by prejudice, matured by a serious and candid consideration of the evidence that will be laid before them, and on which may depend life itself, or much that renders life desirable.

I have been led to believe that such an attempt may at this time prove of considerable service, in consequence of facts which have lately come under my own observation, and which have induced me to pay more attention than I had previously done to this singularly curious and interesting subject.

The facts to which I allude are—1st. The prevalence of Small Pox to a considerable extent in the town and neighbourhood of Newcastle, by which a number of deaths among children, who had not been vaccinated, has been occasioned.—2dly. The occurrence of the disease in many individuals, who had gone through the process of Vaccination; though in every instance as far as I have been enabled to ascertain, it has been so mitigated in the violence of the attack as to preclude any degree of danger, and has never run the regular course of the genuine Small Pox.—3dly. The impression, which these occurrences have made upon the minds of those in whose families they have taken place,—an impression not only unfavourable to Vaccination, but which has induced some to entertain the idea of again having recourse to inoculation for Small Pox.—And, 4thly. The occurrence of Small Pox itself a second time in an individual, who bore ample marks of having already gone through that disease, which she stated to have taken place naturally when young: this patient was a servant in a family where three instances had occurred after Vaccination, and, as in them, the disease was of a mild and modified character.

In all the cases of Small Pox after Vaccination which I have myself witnessed, or of which I have been enabled to obtain any distinct account, the disease has been of so mild a character, and so curtailed in its duration, that could it have been separated from the terrific name of Small Pox, it would have excited no apprehensions in the minds either of the patients themselves or of those around them. But it unfortunately happens that this disease is associated in our minds with so many terrific accompaniments (which were once indeed its constant attendants and consequences, and which belong to it in its natural form, but which, after the employment of Vaccination, have no existence whatever), that it is difficult for the mind to break through this association, and to feel satisfied that though Small Pox may still appear as an occasional visitor, yet, to the vaccinated, it is completely stripped of all that rendered it dangerous in its attack and serious in its effects.

I have had repeated opportunities lately of pointing out this satisfactory distinction to the parents of children who were affected with Small Pox, both after Vaccination and when no such protecting influence had been employed. The contrast between the characters of the disease, as evinced in these different individuals, was too striking not to carry immediate conviction to the minds of all present; and I believe it has been of considerable service in inducing many to have their children vaccinated, who would otherwise have omitted it altogether. These cases occurred among the lower orders of society; and I feel assured that this demonstrative proof of the utility of Vaccination will do more to remove the prejudices of these people than any abstract reasoning from facts of which they have not themselves been witnesses, however numerous and well authenticated. I should, therefore, strongly recommend it to every practitioner to take advantage of any opportunities that may be afforded him of pointing out this most marked distinction between the natural and modified Small Pox.

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CHAP. I.

We shall best estimate the value of any means of removing an evil, by enquiring, in the first place, into the extent of the effects of the evil which it is our object to remove. And we shall also form the most correct estimate of the value of the means which have been employed for its removal entirely, or in part, by reverting to its extent previous to the employment of such means, and comparing the amount of its former ill consequences, with those which are still produced by it.

To satisfy ourselves on the subject of the present enquiry then, it will be useful to put the following queries:—1st. What were the destructive consequences of Small Pox previous to the introduction of Vaccination? And, 2ndly, What influence has Vaccination exerted over these consequences—1. by extensively superseding the cause—and 2. by essentially interfering with the effect?

To answer the former question satisfactorily, it will be necessary to enter, at some length into the history of Small Pox, before Vaccination was proposed as a means of prevention. But it will be remembered, that previous to that era, a means had been already long in use, for the purpose of diminishing, at least, the danger of this terrific disease; and that for half a century the Small Pox had been communicated to thousands annually by inoculation, with the view of accomplishing this very desirable end. This will naturally give rise to a second division of the history of Small Pox. Our first enquiries will therefore be directed to the time antecedent to the use of inoculation for Small Pox, when no artificial measures were adopted for protecting mankind from its fatal attacks.

Although from the vague accounts which earlier European writers have given of the diseases which came under their notice, it is not always easy to distinguish very accurately the precise extent to which Small Pox proved fatal among the nations of Europe, it is yet pretty certain that for a thousand years before inoculation was introduced, it was one of the most destructive scourges of the human race, frequently destroying thousands and tens of thousands, in any district where it occurred. It was at this time frequently included under the general term plague or pestilence, which was applied to every destructive epidemic that took place. It is not necessary, however, for my present purpose to go back to these remote ages; for, independent of the impossibility of obtaining sufficiently authentic information whereon to found any accurate argument, it is not to be doubted that the fatality of Small Pox, in common with that of every other disease, would then be materially greater than in the present day, in consequence of the want of cleanliness and ventilation in our cities and houses, and of good medical treatment. It will not be difficult, however, to produce ample proof of the great mortality occasioned by this disease, at a period when these disadvantages were less felt, and when the nature of it was sufficiently certain. For this purpose I have drawn up tables from the bills of mortality of London, comprising a period of 120 years, viz. from 1703 to 1823, which will form the basis of my arguments.

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Footnote 2:

According to Mr. Moore, (History of Small Pox, p. 66-7) the Small Pox was first introduced into Europe during the invasion of Spain by the Saracens, in the commencement of the eighth century: after which, the infection rapidly spread into France and other countries.

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Mr. Moore, in his History of Small Pox, (p. 243) tells us that “Dr. Jurin took the lead in replying to the opponents of this practice (inoculation for Small Pox): and being a calm man, well skilled in calculation, his writings were composed with great good sense and good temper. He drew his arguments chiefly from an accurate examination of the London bills of mortality for forty-two years, and from accounts collected from a few large cities: and he compared the numbers who died of the Small Pox with the general mortality. From all which he concluded,

“That of all the children that are born there will, some time or other, die of the Small Pox, one in fourteen.” And “that of persons of all ages, taken ill of the natural Small Pox, there will die of that distemper one in five or six.”

In other countries this disease appears to have been yet more fatal than in England. I shall, however, revert to the documents which I have myself collected on the subject.

The tables, which I have constructed, embrace a period of 20 years before inoculation was at all employed in this country—the whole period during which it was in use—and the time which has elapsed since the introduction of Vaccination. We shall thus be enabled, at a single glance, to compare the mortality of Small Pox under each of these several circumstances. In the first column of the table (No. 1.) is shewn the total number of deaths which occurred within the bills of mortality during each successive year, and in the second column, the number occasioned by Small Pox alone.