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From this table it appears that the proportionate mortality from small-pox, which, before 1800, when vaccination began, was about one in every ten deaths, is now reduced to about three in every hundred deaths, and is therefore only between one-third and one-fourth of what it was prior to the introduction of vaccination.
However favourable this result really is, still it does not even approach the expectations which in the infancy of the practice of vaccination was held out by it. In fact, Dr. Jenner had given undue advantage to the first class of objectors, by claiming more for the discovery than it has since been found entitled to. He had announced it, not as an almost certain, but as an infallible preventive of small-pox. The fate of the new practice was thus made to hang on the occurrence of a single case of small-pox after vaccination. Real or reputed cases of the kind did occur; investigations were required of the board, reports on which were to be drawn up and laid before Parliament. Subsequent experience having shewn that the occurrence of small-pox, in a modified form, after vaccination, is not unfrequent, the pretension to perfect immunity from small-pox has been abandoned, a high degree of probability has taken the place of certainty, and the necessity of investigating every case of the kind has disappeared.
The views of the Committee appear to be decidedly in favour of continuing the Vaccine Board, seeing that the effect of vaccination in diminishing the number of deaths from small-pox in a mixed
population, composed partly, of persons who have been vaccinated and partly of persons who have not, has been made apparent in the foregoing abstract from the bills of mortality. With regard to those who have undergone vaccination, the Committee have not been able to learn with precision in what proportion they are liable to small-pox, nor in what proportion cases of small-pox after vaccination are fatal. A return has been made by the National Establishment, purporting to give, as the result of their experience during the last seven years, the number of patients vaccinated by each stationary vaccinator, and out of those patients the number who, to the knowledge of the vaccinator, were subsequently affected by modified small-pox. The proportion, as stated by the different vaccinators, varies from 7 cases in 10,000, up to 70; nor, considering how the information is obtained on which the return is founded, is this wide difference in their statements to be wondered at. Such a return, to justify the drawing any certain conclusion from it, should be founded on a sedulous inquiry, tracing out for a series of
years the history of as many of the vaccinated patients as possible, in of their being or not being subject afterwards to small-pox. The return in question appears to rest on that number of medical cases only which have fallen casually under the notice of the vaccinators. The labour and difficulty (that would attend such an inquiry as is above suggested, preclude the possibility of its being undertaken by
the vaccinators of the Board. Considering, therefore, how many cases of small-pox after vaccination must escape the notice of the vaccinator, it is probable that the real proportion of such cases is greater than the greatest proportion stated in any one of the returns in question; that is, than 7 in 1,000. The return of the National Establishment states also, that, during the last seven years, out of 83,647 vaccinations by the stationary vaccinators, two cases only came under their notice in which small-pox afterwards occurred attended with a fatal result; and in one of these two cases it was doubtful whether the disease was really small-pox. The objections that were made to the statements of the number of cases of smallpox after vaccination, as being inconclusive, will apply also to this return. More information, however, on this part of the subject, has been obtained from Dr. Gregory, Physician to the Small-pox Hospital, who states, that out of 1,785 cases of small-pox admitted into the hospital in the last seven years, 619 were cases occurring after reputed vaccination; of the 1,166 remaining patients who had not undergone vaccination, 494 died ; that is, 42 per cent. Of the 619 patients who were reputed to have undergone vaccination, 40 died; that is, only 6 per cent., which is one-seventh only of the mortality that befel the non-vaccinated patients. The mortality of 6 per cent. must far exceed the average mortality in small-pox after vaccination, since it is only in the worst cases of the disease, and not in the mild and modified form in which it usually appears after vaccination, that the patient would be thought to require hospital assistance.
Were it assumed, as a basis on which to calculate, that out of every 100 persons vaccinated one is attacked with small-pox, and that out of every 100 such cases five were fatal, it would follow, that out of every 10,000 persons vaccinated, five only, or out of every 2,000 persons vaccinated one only, would die of small-pox; but the real proportion is probably much less than this.
In addition to the practical conclusions drawn from this report, which have been already cited, a few more may be added from the answers of the witnesses. A person, for instance, may be exposed to small-pox for ever without taking it; once he has imbibed the disease, vaccination will produce no good effect. If, after recent vaccination, a patient imbibes the small-pox, it will happen in some instances, but by no means generally, that, as the cow-pox comes to maturity, it will destroy the poisonous influence of the other. But the two diseases have gone on at the same time, and the pustules of each will appear together; but many deaths have taken place in cases where the two diseases are synchronous. Those who have had the small-pox, either naturally or casually, are liable to it again; but they are less so than those who have been merely vaccinated. But the most experienced of the professional witnesses recommend that vaccination alone should be resorted to, as it avoids any chance of death, which certainly is
risked in all cases of inoculation. In reference to vaccination, it may be proper to add, that there is a great number of skin diseases which interfere with the cow-pox; for example, it is not uncommon for the vaccine matter to assume the external character of these diseases when they pre-occupy the surface. The cowpox is, under such circumstances, highly infectious.
It is curious that, in winter, vaccination does not succeed in any thing like the proportion that it does in summer, such is the effect of cold on the body; but small-pox, it should be remembered, is equally violent in its activity at all seasons. 1
It appears that the prejudices against vaccination are by no means yet completely got rid of, even by medical men. A low class of practitioners even still exist, who insist on the necessity of inoculation, either from thirst of gain, or from the excess of their hostility to it. Prosecutions have been brought, according to law, for punishing persons who have introduced the small-pox into a new neighbourhood by inoculation. Dr. Hue stated to the committee, that a female at Banbury, with the best intentions, but very little education for that purpose, volunteered to vaccinate the poor. The manner in which the operation was performed was very rude; it was done, as she expressed it, by cutting, and the consequence was, that it produced inflammation and a large scar, like a burn
arm, and brought on a disease totally different from that mild form which we wish to substitute for a loathsome disease, and the consequence was, that one individual actually died of small-pox afterwards in the Small-pox Hospital; a sure proof of the want of dexterity in introducing the lymph, and the false security into which she lulled that unfortunate being.
Mr. Charles Murray, the secretary to the Vaccine Board, states also, there are magistrates and others who occasionally write from the country, stating that itinerant inoculators are going about and spreading the small-pox. Cases of that kind occur; and professional men occasionally write to say, that some new practitioner has come down and offered to inoculate for the small-pox for a very small amount, by which means the small-pox, which had been absent from a place for a considerable time, has been introduced, and wishing to know if there were any means by which those persons could be punished or prevented; and those are cases which have called upon him to correspond with individuals from time to time.
Another curious fact is, that the children of poor persons are altogether unfit to furnish healthy lymph for the purposes of vaccination, and very seldom do they shew a fine vesicle. When wanted in the country, lymph is sent from London, in tubes hermetically sealed, but experience has shewn that lymph collected in any great quantity, or exposed to warmth, will ferment and become effete, and of course insufficient. The lymph is sometimes
fixed on points of ivory, which are very expensive, and very commonly between pieces of square glass.
The source from which the Vaccine Board derived their original lymph, was a patient of Dr. Jenner's; that of the Small-pox Hospital, where vaccination has been carried on since 1799, the disease was taken from cows. The note of the old apothecary to this hospital, written at the time, was as follows:-" Vaccination was first introduced into practice at the Inoculation Hospital by Dr. Woodville, with the disease taken from the cows belonging to Thomas Harrison, esquire, of Gray's-Inn-lane, St. Pancras, on the 19th day of January, 1799; and six patients were vaccinated by the doctor, in the presence of Sir Joseph Banks, Bart., Sir William Watson, Drs. George Pearson, Maxwell, Garthshore, W. Willan, and other gentlemen.
The following portion of Dr. George Gregory's evidence supplies some information on this subject:
1044. What do you know of an experiment which is said to have been made of impregnating the surface of a blanket with small-pox, wrapping up a cow in that envelope, and communicating to thecow the vaccine disease ?—The original experiments are reported to have been made at Bremen by Dr. Sonderland; they will be found reported in Hufeland's periodical publication. The experiments were repeated carefully at the Small-pox Hospital the year before last, under the superintendence of the surgeon of the Veterinary College, Mr. Sewell. The experiment was performed with every attention to accuracy, but no result whatever followed.
1045. Was the experiment made more than once?-Only once.
1046. Then you do not consider it, according to the present state of medical knowledge, as a medical fact that rests upon any authority? I should say none whatever.
1047. Do you believe that experiment at Bremen to have been the origin of the supposed theory that the vaccine disease is smallpox, communicated from the human patient?- It is not the origin of the theory; the theory was originally broached in 1800, or in 1798, by Dr. Jenner, but it is one of the few experiments that have ever been made with a view of determining the point.
1048. But you believe that that is the experiment which must be referred to by any person who states that small-pox is capable of being so communicated to the cow, and of originating the vaccine disease?-I know of no other.
1049. Is it possible by any examination of the points or glasses that contain the vaccine lymph, to distinguish such lymph from the dried serum of the blood, or even from a small quantity of glue?-No, it is not.
1050. Then a correct preparation of the points and of the glasses must depend upon choosing a vaccinator of knowledge and character; and no examination of such preparations by a medical board can ensure their efficacy?-Not in the slightest degree.
1051.--Nor can ensure that they are really vaccine lymph? Certainly not.
Such are the results of this important investigation which equally affects, in its influence, all classes. They are satisfactory to humanity, and should be diffused in every quarter where an objection to this saving practice exists.
Art. XII.-1. The Naturalists Library. Ornithology. Vol. 1.
Humming Birds. By Sir W. JARDINE, F. R., S.E., F. L. S.
Edinburgh: Lizars. London: Longman & Co. 1833. 2. The Naturalist's Library. The Natural History of Monkeys,
illustrated by thirty-one Plates, numerous Wood Cuts, and a Portrait and Memoir of Buffon. Vol. 1. By Sir W. JARDINE.
Edinburgh : Lizars. London: Longman & Co. 1833. 3. The Animal Kingdom, arranged according to its Organization,
8c., by Baron Cuvier. Translated from the latest French edition, with additional Notes, and illustrated by nearly 500 Plates.
In 4 vols. London: Henderson, 1833. 4. Miller's Gardener's Dictionary, reprinted from the last edition
published during the Lifetime of the Author. London: Hen
derson. 1833. In the works whose titles we have now enumerated, we have an exemplification of the ingenuity which distinguishes the present, inasmuch as they represent an amount of expenditure chargeable on purchasers, which would a few years ago have stood in some six or seven times the sum.
The first of the works, the commencing volume of the Naturalist's Library, contains thirty-four plates of humming birds, more properly speaking, thirty-four representations of those birds, which, it must be admitted by even the most fastidious critics, are executed in the very best perfection of art, including engraving and colouring. The same observations apply to the second of those works; emanating, as it does, from the same quarter, and consisting of thirty-one plates, each representing a single monkey. The letterpress is fully equal as respects its copiousness and its accuracy, to the expectations of every reasonable mind. In truth, these two works present such a wonderful improvement in the facilities now existing for obtaining valuable matter at a cheap rate, that one is astonished to find that even this effort at moderation has been actually outstripped by more enterprising competitors. Taking up the translations of Cuvier, which is now in course of publication, looking at its immense value as the production of one of the noblest intellects of modern times, considering the rich decorations, the triumphs of the graphic art which accompany the letter-press, we cannot hesitate in awarding to this undertaking the credit of being