Chapter I: Part 1

An Estimate of the True Value of Vaccination
as a Security Against Small Pox

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AN
ESTIMATE,
_&c. &c._

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Newcastle; Printed by T. & J. Hodgson,
Union Street

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AN

ESTIMATE

OF THE TRUE VALUE OF

VACCINATION

AS A

SECURITY AGAINST SMALL POX.

BY

T. M. GREENHOW,

MEMBER OF THE ROYAL COLLEGE OF SURGEONS IN LONDON;
SURGEON TO THE LYING-IN HOSPITAL, TO THE CHARITY
FOR POOR MARRIED WOMEN LYING IN
AT THEIR OWN HOUSES, AND TO THE
INFIRMARY FOR DISEASES OF
THE EYE, NEWCASTLE.

“And in order to stimulate the wise and good to aim strenuously at this consummation (the total extirpation of Small Pox), 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.”

_Sir Gilbert Blane._

LONDON:

PRINTED FOR BALDWIN, CRADOCK, AND JOY; AND
EMERSON CHARNLEY, NEWCASTLE.

1825.

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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]

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Footnote 1:

Mr. Wilkie (the respectable resident apothecary at the Dispensary in
this town) lately informed me that a woman, who resides in Sandgate,
after losing _three children_ from Small Pox, during the present
prevalence of that disease, would yet neither use precautions nor
remedial measures for the preservation of the remainder; although she
daily witnessed the efficacy of Vaccination among her neighbours,
even when performed during the existence of Small Pox itself in other
members of the same families.

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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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AN

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[2] 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.

The table (No. 2.) is divided into periods of five years each—it consists of four columns—the first of which exhibits the total number of deaths during each period of five years—the second the number of deaths from Small Pox—the third shows the proportion of the latter in each thousand of the former—and the fourth points out the relative proportion of deaths from Small Pox compared with the whole. I am aware that the two latter columns may be considered as a repetition of the same statement, but I think it may appear more striking when placed in this double form.

When we compare the calculation of Dr. Jurin, which has been quoted above, (published I believe about the year 1723,) with the first twenty years of these tables, we shall find, that, with the exception of the first five years, it is rather below than above the results which they exhibit; that, according to them, for the fifteen years from 1708 to 1723 inclusive, the deaths from Small Pox exceeded one in twelve of the whole,—that in 1710 it was about one in seven, and that in 1719, although the relative number was not quite so great, being in the proportion of one in eight only; yet that the actual number was greater than in 1710, amounting to no fewer than 3229, the total number of deaths being 28,347.

Such was the destructive nature of Small Pox before the introduction of inoculation. Its ill effects, however, were not confined to those whom it precipitated into the tomb. A very large proportion of the living, who were fortunate enough to escape its fatal effects, yet suffered essentially for the remainder of their lives from its injurious attacks, not only in the loss of that beauty of countenance which we all value both in ourselves and in our friends, but frequently in the serious injury or total destruction of one or both eyes,[3] or of the general health of the constitution, which was, in many cases, never afterwards entirely restored, although death was not the immediate result.

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Footnote 3:

“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
Small Pox,”—_Sir G. Blane on Vaccination, p. 9._

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Instances, wherein the beauty of the human countenance has been materially injured by the occurrence of Small Pox in the early stages of life, are now happily 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. There are few of us, however, who are not still acquainted with some, and who cannot recall many more: and we every now and then meet with cases of blindness, which had succeeded to this formidable disease. I have myself had opportunities of seeing several such instances; and it is but a few weeks since my opinion was asked respecting a child, who was recovering from the Small Pox in its worst form, with a countenance dreadfully disfigured, and one eye entirely destroyed.[4]

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Footnote 4:

Since this was written, I have been consulted on account of a little
girl, of seven years of age, who has just sustained the same very
serious deprivation, in consequence of an attack of Small Pox.

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That a disease so destructive of human life, and which frequently entailed on the living such indelible proofs of its severity, should have been anticipated with peculiar feelings of dread and apprehension we can well believe, and it was natural that any method, which afforded a probability of diminishing its danger, and of rendering its attacks of a milder character, should excite no ordinary degree of public attention.

How far these ends were accomplished by the artificial communication of Small Pox by inoculation, we shall now proceed to inquire.

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CHAP. II.

The first individual in England on whom the operation of inoculation for Small Pox was performed, was the daughter of the celebrated Lady Mary Wortley Montague. She had witnessed, when in Turkey, the mildness of this disease as produced by inoculation, and her son had already passed through the process with safety. “The engraftment of her son having succeeded; after Lady M. W. M. returned to London in 1722, she sent for Mr. Maitland, the surgeon, who had attended the boy at Constantinople; and desired him to engraft her daughter with Small Pox. He solicited a delay, on account of the weather, and entreated that two physicians should be consulted. These requests were refused, yet he obeyed her Ladyship’s injunctions; but when the fever commenced, an old family apothecary and three physicians were permitted to witness the process. As the success was complete, Dr. Keith, one of the above physicians, was tempted to request Mr. Maitland to engraft his child also, which likewise succeeded; and these cases were rumoured through the town.”[5]—An experiment was afterwards tried, at the request of the Princess of Wales, upon “six condemned felons” with success, and her own children passed through the operation with safety. After this, inoculation was partially employed for some years, and was again discontinued—but, about the middle of the last century, great exertions were made to bring it into general use, and with a considerable degree of success. We shall presently endeavour to ascertain what influence it exerted over the prevalence and fatality of Small Pox. But, in the first place, I think it will be useful to enquire into some of the arguments which were adduced in support of the practice; and, it may be, to allude to a few which were opposed to it.

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Footnote 5:

Moore’s History of Small Pox, p. 228-9.

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The principal arguments, on which the employment of inoculation for Small Pox was supported, appear to have been the following:—

1. The infectious nature of the disease, which was so virulent as to permit few individuals to pass through life without being at one time or other affected by it.

2. Its fatality—destroying at least one in five or six of those attacked by it.

3. The generally received opinion that no individual could be affected by it oftener than once. And

4. That, when communicated by inoculation, it was rendered comparatively mild and devoid of danger, while it afforded equal security against any future attack of the disease.

The two former of these positions need not engage our attention in this place—the highly infectious nature of Small Pox has always been admitted; and I have already brought forward sufficient proof of the danger to human life which it occasions.

The third proposition is of most material importance; for I am well convinced that upon a proper understanding of this question depended the true value of inoculation as far as regarded _individuals;_ and on it also rests the true value of Vaccination as regards _society in general_.

It was unfortunate for the cause of inoculation that its early advocates maintained the absolute impossibility of Small Pox occurring a second time in the same individual. They thus furnished their opponents with weapons against themselves, in the cases, which repeatedly occurred, of those who had passed through the process of inoculation being afterwards affected by the natural Small Pox; and were put to the necessity of having recourse to expedients equally unmanly and uncandid—either of denying that the second disease was genuine Small Pox, or of asserting that the inoculating process had been imperfectly performed. Whereas a little attentive observation and research into the former history of Small Pox, might have satisfied them, that although in a great majority of cases this formidable disease did not occur a second time in the same person, yet that repeated instances took place wherein it did so occur. And that while it might be assumed as a general rule that the same individual would be affected once only with Small Pox—it was a rule admitting of exceptions.

That a second attack of Small Pox may take place in the same individual, may be proved by a mass of evidence which appears to me to be perfectly irresistible; and as I consider it very important to the object of this enquiry that every doubt should be removed on the subject, I must be permitted to dwell on it longer perhaps than may at first sight appear necessary. I have great pleasure in acknowledging my obligation to the valuable “Historical Sketch of Small Pox,” by Professor Thomson of Edinburgh, for a large share of the evidence which I shall lay before my readers, to prove the frequency of the recurrence of Small Pox. Soon after the introduction of inoculation into France, “a son of M. Delatour, about nine years of age, was inoculated in 1756 for Small Pox, by Surgeon Martin, under the inspection of M. Tronchin, and passed through the disease in a satisfactory manner. This boy remained in good health for upwards of two years, when an eruption, supposed by some to be Small Pox, appeared upon him, as well as upon four of his companions in the same boarding-school. The different opinions formed of the nature of this eruption by the medical practitioners who saw it, and who seem to have judged of it according to the preconceived notions they entertained with regard to the possibility of the recurrence of Small Pox, present (says Dr. Thomson) so true a picture of what has occurred in similar cases since the introduction of Vaccination, and of the manner in which doubtful cases of varioloid eruptions continue still to be judged of, that I cannot avoid giving you an abstract of the discussions to which this case gave rise.”[6]—Dr. Thomson goes on to say, that “M. Gaulard, Physician in ordinary to the King, was called to see the son of Delatour on the third day of the eruption, which he declared to be a mild case of Small Pox, of the kind commonly called, he says, though improperly so, Chicken Pox, and the disease in the boy’s companions he considered of the same nature.”—Four physicians were called in to consult with Mons. Gaulard, who[7] “gave an account of the progress of the disease which contains a description of varioloid eruptions, very similar to those which have of late been described under the denomination of modified Small Pox.

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Footnote 6:

Dr. Thomson’s Sketch, &c. p. 53.

Footnote 7:

Dr. Thomson’s Sketch, &c., p. 54.

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“These gentlemen mention also, that _two_ of the other children affected, had previously passed through natural Small Pox; and conclude with declaring that, from these circumstances, they believe that the disease in Delatour and his companions, _was neither the Small Pox nor the Chicken Pox, but a chrystaline eruption, with which they were well acquainted_.”

It is, I think, from this sufficiently evident, that nothing but the preconceived opinions of the physicians consulted in these cases could have prevented their acknowledging the true nature of the disease; and there cannot, I conceive, be a doubt, that it was no other than Small Pox rendered milder in its character by the previous occurrence of it in these children. It is of importance too to remember that they afford examples of the recurrence of the disease after both _natural_ and _inoculated_ Small Pox. Delatour had been inoculated upwards of two years before, and “two of the other children affected had previously passed through natural Small Pox.” I shall here adduce some further extracts from Dr. Thomson’s work. He tells us that “M. Hosty, who had been sent over to England in 1755, to acquire information upon the subject of inoculation,” “enters into a discussion with respect to the recurrence of secondary Small Pox, in which he allows that there are several eruptive diseases with which a person may be affected, _so like the Small Pox, as scarcely to be distinguishable from them_, and, on that account, liable to give rise to many mistakes; and he states, that although he does not deny absolutely the possibility of the recurrence of Small Pox, he believes this to be rare,” (p. 55-6). “To Hosty’s opinion, with regard to the unfrequency of the occurrence of secondary Small Pox, Gaulard replied, that he had at that time under his charge two unequivocal examples of secondary natural Small Pox, and that a nephew of the Archbishop of Paris, had a month before passed through the Small Pox, under the care of the celebrated M. Astruc, although he bore marks on his body of having formerly undergone the disease.”—(p. 59.)

Gaulard then declares, “that though reason dictates, and _experience actually demonstrates_, that this process (inoculation for Small Pox) does not infallibly afford protection against a subsequent attack of natural Small Pox, he was still disposed to believe that it may be possessed of some real advantages” (p. 59). “Dr. Cantwell, in 1755, published a dissertation upon inoculation, the avowed object of which was to _undeceive_ those who believed in the efficacy of that practice. In this Essay, a great number of cases of Small Pox, which had occurred both after natural and inoculated Small Pox, are mentioned” (p. 64). “He (Dr. Cantwell) seems to have been well acquainted with those varioloid eruptions which, previous to the introduction of inoculation, had received a variety of names, such as Swine Pox, Chicken Pox, &c. and which were considered not as specifically different from Small Pox, but as spurious and bastard species of that disease. These eruptions, in his opinion, were nothing else than mild varieties of the true Small Pox. His own words are” (p. 37), “after all, what are the Swine Pox, the Duck Pox, and the Chicken Pox, which are observed among the English and the Irish? What is the _petite verole volante_ which is seen in France? Many distinguished authors attest, that they have seen Small Pox occur twice in the same individual; and have not we reason to believe that, in these cases, the second attack was true Small Pox, of which the infection was slight, and in which the vital actions were too weak to carry it to a certain extent?” All this appears to me most strictly consistent with truth. But Dr. Cantwell was arguing against the use of inoculation. How then did he account for the fact that “the infection was slight,” and that “the vital actions were too weak to carry it to a certain extent,” if it did not arise from these individuals having already passed through the disease of Small Pox?

“De Haen (a celebrated physician of Vienna,)” says Dr. Thomson (p. 68), “collected into a body the numerous cases of secondary Small Pox, which are to be found in the writings of physicians, who lived previous to, and in the infancy of, the practice of inoculation in Europe. Had the number of these cases, and the respectability of the individuals by whom they are related, been duly considered, they surely were more than sufficient to have satisfied the minds of the most incredulous, of the possibility, and even of the frequency of secondary Small Pox.” De Haen, however, was an opposer of inoculation, and the facts he adduced were not permitted to have the weight which they merited, in consequence of the arguments he deduced from them.

I shall conclude my extracts from the fund of evidence collected in the work of Professor Thomson, with the following:—

“M. Strack, professor of medicine at Mayence, in a letter upon inoculation, addressed to M. Roux in 1765, (Journ. de Med. tom. xxii.) maintains that natural Small Pox do not, any more than the artificial, protect against a second attack. In proof of his opinion, he mentions six cases of secondary Small Pox which he himself had attended. The argument which he uses in support of inoculation, in opposition to those who were hostile to that practice, and who asserted that it does not protect against a subsequent attack, though novel at the time it was employed, has since been sufficiently confirmed by repeated observation. He says, that those who have passed through the Small Pox twice, whether naturally or artificially, have, in general, escaped without danger; those patients, he adds, who have had the Small Pox at two different periods, are fortunate, because if the variolous miasma had operated with its full force during the first attack, they probably would have fallen victims to the disease” (p. 77).

Mr. Moore remarks (Hist. of Small Pox, p. 278) that, “besides the foreign authorities, the English Medical Journals contain several authentic examples of persons whose faces were strongly pitted with Small Pox, and who were afterwards destroyed by a second attack 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 sent for by a lady unknown to him, and conducted by her maid, rather mysteriously, into a handsome bed-chamber; where he saw, lying in a splendid bed, a lady masked. Being a good deal surprised, the maid stifled a laugh, while her mistress, in a soft toned voice, apologised for concealing herself even from a professional gentleman. This (she said) had become proper, from the peculiarity of her situation. At present she stood greatly in need of his superior medical talents, and was extremely anxious for his opinion on her case, which she understood from others, was a very rare one. The doctor being thus put upon his guard, enquired minutely into all the symptoms, and examined critically a pustular eruption which was spread over the lady’s person: he then pronounced the disease to be, without all doubt, the Small Pox. On which the patient unmasked, and displayed features seamed with the disorder.”

Dr. Thomson (in his Historical Sketch, p. 279) informs us, that out of _eight hundred and thirteen_ cases of Small Pox, which had come under his notice since June, 1818, “_seventy-one_ had previously passed through Small Pox.” And in the sequel many other instances will be referred to.

In a late number of the London Medical Repository, Dr. Carter, of Canterbury, gives the details of a case of secondary Small Pox occurring in a girl, which proved fatal. And a young lady (a family connection of my own), who had satisfactorily passed through the disease, from inoculation, when young, had a second attack of Small Pox, when on a visit at Liverpool, to which she very nearly fell a sacrifice. To this mass of evidence I shall add the case to which I have before alluded, as having come under my own notice. In this young woman the eruption was confined to the shoulders and face, and was not numerous, but it was preceded for several days by considerable feverishness and head-ache; and although it did not proceed beyond the fourth or fifth day, I consider the nature of the disorder as quite unequivocal; if what I conceive to be the only true test of this be admitted, namely, that it was produced by Small Pox infection, and was capable of communicating it to others. Fortunately this test was left incomplete in this instance, no other individuals having become infected in consequence; but the following facts which have since come to my knowledge, seem to warrant the inference, that this might have happened had any unprotected persons been allowed to have communication with the patient.

A lady, residing at Gateshead, who passed through inoculated Small Pox many years ago, became lately (during her confinement) affected a second time with this disease. And notwithstanding that it was of the same mild character as in the last case, and that the eruption turned on the eighth day, her infant caught the infection. The eruption in the child was of the confluent kind, and occasioned its death eight days after the appearance of the disease.

Having succeeded, I trust, in proving to the entire satisfaction of every candid enquirer the possibility, if not the frequency, of the occurrence of Small Pox a second time in the same individual, it would be both interesting and useful, were it possible to ascertain what proportion such cases bear to those who escape a second attack; but many insurmountable difficulties present themselves in making such a calculation. Dr. Thomson tells us (p. 67), that “according to Tissot, the proportion of cases of secondary Small Pox, is as 1 in 100; according to Heberden, as 1 in 5000; and, according to Condamine, as 1 in 10,000. How uncertain the data!”—It is, however, enough to know, that while the relative number is sufficiently great to prevent the rule, That no individual can be affected by Small Pox oftener than once,—from being considered absolute, it is yet too small reasonably to shake our confidence in the fact, that a very large proportion will escape a recurrence of that disease. One other fact of considerable importance has, I trust, been also established by the preceding enquiry—That when secondary Small Pox does take place, it is usually a very mild disease, unattended with danger.

The fourth argument in support of the employment of inoculation for Small Pox,—that it was rendered comparatively mild and devoid of danger, while it afforded equal security against any future attack of the disease with natural Small Pox itself, need not detain us long.—The latter part of the proposition has been generally admitted; 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 commencement of inoculation in England, the proportion of fatal cases appears to have been fully one in fifty. But after the last improvement in treatment had been established, probably not more than one in two hundred were lost.”—Mr. Moore continues—“of those who contract the casual Small Pox, and are treated with medical care, it has been admitted that generally about one in six are lost: but in countries where the medical arts are unknown, the Small Pox is so fatal a disease that few of those who are seized with it survive its malignity.” The immense difference between these proportions is amply sufficient to prove the great advantage derived from inoculation by those on whom it was practised.

Such then were the data on which the practice of inoculation for Small Pox was established. But it will be remembered, that on its introduction, and for many years after it had been extensively used, it met with a very warm opposition both from medical men and others, especially from some zealous divines, who stigmatised it as “a diabolical invention of Satan,” and uttered anathemas against all who should practise it. I shall not enter into any examination of the arguments made use of by the opposers of inoculation; some of them have been already alluded to, and their fallacy pointed out. Taken altogether, it is remarkable how nearly they resembled those which have been opposed to the introduction of Vaccination. Now, that distance of time has enabled us to view the facts of the case with coolness, and to reason upon them without prejudice, while we admit the individual security which arose from the practice of inoculation, we must in candour confess its tendency to encrease the general destruction of life from Small Pox, by forming so many new sources of infection. This was the only rational argument against inoculation, but it was certainly one of great force, and the actual encrease of deaths from Small Pox during the prevalence of inoculation, seems to prove that it was never sufficiently considered. The encreased number of deaths from Small Pox in 1723 and 1725, might fairly be imputed to this cause, although it was denied at the time by Dr. Jurin. Mr. Moore (History of Small Pox, p. 243) very satisfactorily replies to Dr. Jurin’s argument in the following extract. “And as in the year 1723 a great increase of the mortality by Small Pox took place in London; Dr. Jurin expressed his opinion that this ought not be imputed to inoculation, as the numbers who had been inoculated did not exceed sixty. This was a very inadequate answer. A single person may bring the plague into a town or into a nation, and be the cause of the destruction of an innumerable multitude. The Small Pox is fully as infectious a disease as the plague; and sixty inoculations were more than sufficient to 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 to 1798 inclusive (the period during which inoculation was most extensively employed in this country), the average mortality from Small Pox, during periods of five years each, was occasionally so high as one in eight of the whole, and rarely less than one in ten. And that during individual years, it three times (in 1752, 1781, and 1796) amounted to nearly one in five; and in 1772 was little less than one in six. This is surely a fearful encrease on Dr. Jurin’s calculation—“That of all the children that are born, there will some time or other die of Small Pox _one in fourteen_.” There can be no doubt, however, that this immense encrease of mortality from Small Pox was owing to the extended practice of inoculation; and until this could have been pursued more generally, and with greater precautions, so as at once to diminish the numbers capable of being infected by the inoculated, and the hazard of the latter coming into contact with the unprotected, I am disposed to think this fact was in itself sufficient ground for discontinuing inoculation for Small Pox altogether. Could every child have been subjected to the process of inoculation, before any exposure to the infection of natural Small Pox had taken place, the case would have been widely different: but it can scarcely be considered either just or politic to render one individual secure at the risk of endangering many, or with a certainty of destroying some. It may fairly be concluded, then, that inoculation for Small Pox, as practised for the last fifty years of the eighteenth century, although certainly _a great individual good_, was, in reality, without a doubt, a _most serious general evil_.

From what has been hitherto stated, I conceive, we are authorised in assuming the following as facts, which will furnish a satisfactory answer to the first of the questions proposed, What were the destructive consequences of Small Pox previous to the introduction of Vaccination?

1. Small Pox is a disease of so infectious a nature, that few individuals passed through life without suffering from an attack of it.

2. It was attended with so much danger as to occasion the death of one in five or six of those affected by it in the natural way; and previous to the use of inoculation, one in fourteen of the whole number of children born, at one time or other, died of the Small Pox.

3. Of those who recovered, many suffered materially from its effects, not only in the disfigurement of countenance occasioned by it, but frequently in the loss of one or both eyes, or in irreparable injury of their constitutions.

4. After having been once affected by Small Pox, a very considerable proportion of individuals resist entirely a second attack: but still in very many instances a recurrence of the disease is proved to have taken place.

5. Secondary Small Pox is, for the most part, very mild in its symptoms, and of shorter duration than a first attack, insomuch as to have frequently given rise to doubts respecting the real nature of the disease.

6. Secondary attacks of Small Pox have, nevertheless, occasionally proved fatal.

7. When artificially produced by inoculation, the Small Pox is rendered materially milder in its character, so that one in two hundred only of those to whom the disease has been thus communicated, have been found to die in consequence.

8. The Small Pox, when communicated by inoculation, is probably as secure a preventive of any future attack of the disease as when it has taken place naturally.

9. Notwithstanding the undeniable advantages which accrued to those who passed through the process, it was, nevertheless, the direct effect of inoculation, by multiplying the sources of infection, materially to encrease the aggregate mortality occasioned by Small Pox.

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CHAP. III.

Such having been proved to have been the destructive consequences of Small Pox, previous to the introduction of Vaccination, we are fully prepared to enter upon the second query proposed,—What influence has Vaccination exerted over these consequences—1. by extensively superseding the cause—and 2. by essentially interfering with the effect?

The name of Dr. Jenner is too intimately associated with the subject of Vaccination to admit of the latter being referred to without some allusion being made to the former; and I should ill testify my sense of the truly valuable blessing which Jenner has been the means of conferring upon mankind, were I altogether to omit any expression of my admiration of the superior perception which enabled him to infer the probable consequences of facts, which must have been long familiar to hundreds without having given rise to any important suggestion, and of the zeal and ability with which he prosecuted his enquiries on the subject, or my high esteem for the generous disinterestedness with which he made known to the world his most useful discovery. “It will,” (to use the words of Sir Gilbert Blane,) “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.”

It is not, however, my intention to enter into any detail of the mode in which Vaccination originated, or of the circumstances which accompanied its introduction into practice. It will suffice to state, that its supposed efficacy in preventing the occurrence of Small Pox, was founded upon repeated observation, that the milkers employed in the great dairies of Gloucestershire and the neighbouring counties, who became affected with a disease which prevailed among the cows, and to which the name of Cow Pox had been given in consequence, were very generally rendered insusceptible of the Small Pox infection, even when attempted to be communicated by means of inoculation. Dr. Jenner put this fact to the test of repeated experiment, and finding it thus confirmed, proposed introducing the Cow Pox into the human constitution artificially, as a means of securing it against the dangers of Small Pox, and, in the end, of entirely exterminating the latter disease; for it must appear very evident, that if every individual could in any way be rendered incapable of being infected by Small Pox, the infection itself must necessarily become entirely extinct.

In prosecuting my enquiries into this part of my subject I shall, as far as may be, confine myself to an examination of facts calculated, as I conceive, to remove every reasonable doubt respecting the true value of Vaccination.

The first essential fact, to which I would direct the attention of my readers, is the very striking diminution in the number of deaths from Small Pox, which has taken place within the bills of mortality of London, since the introduction of Vaccination. This diminution is equally remarkable, whether we refer to the actual number of deaths from this cause, or to the relative proportion which they bear to the whole amount of deaths occurring in any given year or number of years. Thus taking the averages calculated on periods of five years each, as is shewn in the table (No. 2), it will appear evident not only that the amount of diminution has been most gratifying and satisfactory, but that, in proportion to the increasing employment of Vaccination, it has been regularly progressive; so that the number of deaths from Small Pox, instead of amounting to one in ten of the whole, as was the case for the ten years which preceded the introduction of Vaccination, has during the last ten years, actually amounted to less than one in twenty-eight, or little more than one-third of the former proportion.

If we compare the number of deaths from Small Pox, which took place during the twenty-five years (from 1784 to 1798 inclusive) which immediately preceded Vaccination, amounting to 46,996, with the number which has taken place during the twenty-five years which have elapsed since its introduction (from 1799 to 1823 inclusive), amounting to 25,869, we shall find that an actual diminution has taken place of no fewer than 21,127, or nearly one half of the whole. It may, therefore, be confidently assumed, even upon this very simple calculation, that a number of lives equal to this diminution has been saved by Vaccination, within the bills of mortality alone. And as this diminution in the amount of mortality from Small Pox is going on in a progressive ratio, it is probable that the next twenty-five years will afford a yet more striking result.

If we extend this calculation to the whole of Great Britain and Ireland, assuming that the ratio in the diminution of deaths has been the same over the united kingdom as within the London bills of mortality—(and there are various good reasons for believing that it has been greater)—we cannot but be struck with the immense saving of human life which has already taken place. Sir Gilbert Blane and Dr. Letsom separately calculated the annual loss of lives from Small Pox, in Great Britain and Ireland, during the last thirty years of the eighteenth century.—One of these eminent physicians estimated them at 34,260, and the other at 36,000 (Moore’s History of Small Pox, p. 300): For our present purpose, we will take a medium number, as being probably nearest to the truth. Assuming then, that the number of deaths from Small Pox, in the United Kingdom, during each of the twenty-five years which preceded the introduction of Vaccination, amounted to 35,000, the amount, during the whole of that period, must have been 875,000. But if the diminution on the whole of this number has been equal to that which is proved to have taken place within the London bills of mortality, during the last twenty-five years, it must have been reduced to 481,644 only, and an actual saving of the lives of 393,356 individuals must have been accomplished.