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

------------------------------------------------------------------------




                                   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]

-----

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.

-----

 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.

-----

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.

-----

 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.

-----

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._

-----

 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]

-----

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.

-----

 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.

------------------------------------------------------------------------




                               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.

-----

Footnote 5:

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

-----

 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.

-----

Footnote 6:

   Dr. Thomson’s Sketch, &c. p. 53.

Footnote 7:

   Dr. Thomson’s Sketch, &c., p. 54.

-----

 “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.

------------------------------------------------------------------------




                               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.

 These calculations agree pretty nearly with estimates published in the
 year 1820, by Sir Gilbert Blane, founded on similar documents. His
 calculations extend to the parishes not included within the bills of
 mortality, and he comes to the following conclusion on the subject:—“It
 appears, therefore, that even under the very imperfect practice of
 Vaccination, which has taken place in the metropolis, 23,134 lives have
 been saved in the last fifteen years, according to the best computation
 that the data afford”—(Sir G. Blane on Vaccination, p. 7). But however
 remarkable and satisfactory this immense saving of human life, in the
 country where Vaccination originated, may appear, as an unanswerable
 evidence of its efficacy, the result has been still more decisive in
 many foreign countries, where it has been much more generally employed.
 In proof of this, I shall again quote the very valuable little work of
 Sir Gilbert Blane, (which, by the way, I should strongly recommend to
 the attention of the public, as containing much valuable matter and
 sound argument within a very small compass). He states, (p. 7-8) “In
 the summer of 1811, the author was called to visit, professionally, Don
 Francisco de Salazar, who had arrived a few days before in London, on
 his route from Lima to Cadiz, as a Deputy to the Spanish Cortes. He
 informed him, that Vaccination had been practised with so much energy
 and success in Lima, that for the last twelve months there had occurred
 not only no death from, but no case of, Small Pox: that the new born
 children, of all ranks, are carried as regularly to the Vaccinating
 house as to the font of baptism; that the Small Pox is entirely
 extinguished all over Peru; nearly so in Chili; and that there has been
 no compulsory interference on the part of the government to promote
 Vaccination.”

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

 “These are selected as some of the earliest and most remarkable proofs
 of the extirpating power. But it is demonstrable, that if at the first
 moment of this singular discovery, at any moment since, at the present
 or any future moment, mankind were sufficiently wise and decided to
 vaccinate the whole of the human species, who have not yet gone through
 the Small Pox, from that moment would this most loathsome and
 afflicting of all the scourges of humanity, be instantaneously and for
 ever banished from the earth.” (p. 8).

 These, and such as these, then are the great, the undeniable facts,
 which must, I think, carry irresistible conviction to every reflecting
 and unprejudiced mind respecting the true value of Vaccination. And it
 is these facts which furnish us with an answer to the second question
 proposed—What influence has Vaccination exerted over the destructive
 consequences of Small Pox? which it must be truly gratifying to every
 philanthropic mind to contemplate. In the course of twenty-five years,
 in our own country, where it has been very partially employed, it has
 actually been the means of saving a number of lives, amounting to
 393,356; and if it be true, as supposed by Sir Gilbert Blane, that
 Small Pox induced “blindness, deformity, scrofula, or broken
 constitutions,” in as many who recovered from the disease as died in
 consequence of it, then have an equal number been saved from these
 dreadful calamities. But abroad, where it has been more generally
 employed, Vaccination has, in many places, actually exterminated the
 Small Pox altogether.

 From what has already been said, it will be evident, that Vaccination
 has produced these very beneficial consequences in two ways. 1. By
 superseding an efficient cause of the spread of infection, namely, the
 practice of inoculation for Small Pox. And 2. by essentially
 interfering with the effect of the infectious virus.

 The increased number of deaths, which took place during the period when
 inoculation for Small Pox was generally employed, is sufficient to
 prove the influence of Vaccination to have been considerable in the
 former way; but a formal application having been made to me to
 inoculate a child for Small Pox, since I commenced these remarks, I
 think it right to call the attention of the public more decidedly to
 the pernicious tendencies of the practice.

 The attention of the medical profession, and of the public generally,
 was soon excited by the increasing number of deaths after the
 introduction of inoculation, and exertions were made to check it,
 particularly by the establishment of the Small Pox Hospital. This, no
 doubt, had some effect, by separating a part at least of those to whom
 Small Pox was artificially communicated from the rest of the community;
 but the event proved that this was by no means an adequate defence
 against the factitious causes of infection, which were daily called
 into action. The Small Pox Hospital still exists, and it is a very
 remarkable fact, that, for several years after the discovery of
 Vaccination, out-patients continued to be inoculated at that
 institution. This, no doubt, contributed to prevent the proportion of
 deaths from Small Pox in London from diminishing so rapidly as would
 otherwise have been the case, and as has been the case, since this
 “unaccountable infatuation,” as Sir Gilbert Blane very justly calls it,
 has been discontinued. But, as the same eminent physician properly
 remarks (p. 6), “it was in the rural population that the effect of
 inoculation in diffusing Small Pox was chiefly felt. In this situation,
 there is much less intercourse of persons with each other than in
 towns, so that not only many individuals escaped, from their not being
 exposed to infection during their whole lives, but whole districts were
 known to have been exempt from it for a long series of years before it
 was universally diffused by inoculation.” We may, therefore conclude,
 that while the number of deaths from Small Pox, within the bills of
 mortality, was increased in the proportion exhibited in the tables by
 means of inoculation, in the country the increased mortality from this
 cause was in a much greater ratio. This supposition is in a great
 degree confirmed by the effects occasioned by a renewal of the practice
 of inoculation, in Norfolk, in the year 1819, as recorded by Mr. Cross,
 in his History of the Epidemic Small Pox, which at that time prevailed
 in the city of Norwich and the county of Norfolk. Mr. Cross mentions
 many instances of the disease being introduced into parishes, in which
 it did not before exist, by means of inoculation, the contagion
 afterwards spreading in all directions; and affirms (p. 272), that
 “thirty-eight surgeons, who from various motives, practised it, lost
 among those to whom they had thus given the disease, twenty-one
 patients; fourteen surgeons reported, that fifty-five deaths had been
 occasioned in the same way within their knowledge; and five other
 surgeons observed, that they had known several who fell a sacrifice to
 the practice.” It admits then of the most incontestable proof, and it
 is a fact, which cannot be too deeply impressed upon the minds of the
 public, that inoculation for Small Pox is a practice attended with very
 considerable danger to the individual who passes through it, while to
 society in general, it has been productive of the most pernicious
 consequences. Is it too much then to affirm, that it cannot be employed
 without great moral guilt being incurred both by those who may require
 its performance, and by the medical practitioner who shall be induced
 to practise it?

 But by far the most important mode in which Vaccination has been
 productive of the equally astonishing and gratifying consequences,
 which have been proved to have resulted from it, has been by its
 essential interference with the effect of the infectious matter of
 Small Pox, either by entirely preventing the occurrence of that
 disease, or by stripping it of all its dangerous and formidable
 characteristics—rendering it, in the comparatively few instances in
 which it has taken place at all after Vaccination, mild in its attack,
 and perfectly harmless in its consequences.

 It very generally happens, when a discovery is made which promises to
 exert any considerable influence over the happiness of man, that its
 capabilities cannot for some time be very accurately defined; and that
 the effects, which a few years’ experience shall prove it to possess
 the power of producing, will, at the commencement, be either
 undervalued or overrated. It would not, perhaps, be difficult to adduce
 instances of both. And it can scarcely excite surprise, that something
 like this should have been the case with incomparably the most
 important discovery of modern times, for such we may truly esteem
 Vaccination, whether we consider it as a means of preserving life, or
 of obviating effects, perhaps, even more deplorable than the loss of
 life itself.

 If then, the first promoters of Vaccination were led, from their ardour
 in a cause of such vital interest to the whole human race, and before
 time had been allowed to afford sufficient data whereon to found a more
 correct opinion, to conclude that Vaccination would, in every instance,
 prove an absolute and infallible preventive of future susceptibility of
 Small Pox infection, let us not, on that account, run into an error
 incalculably more dangerous in its tendency, and underrate or deny
 altogether the degree of security which it actually affords. That this
 is more than sufficient to render it worthy of universal adoption,
 there cannot be any reasonable doubt; but it would have been strange
 indeed, if, in the undeviating uniformity of its effects, Vaccination
 had formed a _single_ exception to the _law of uncertainty_ that
 attaches to every other agent, which it has, at any time, been
 permitted to mankind to employ for the promotion or preservation of the
 health of the human constitution: and, considering the innumerable
 varieties which prevail in the latter, we ought rather, perhaps, to
 feel surprise that the influence of Vaccination over all these
 varieties, should have been proved to be so similar as to have
 justified us in considering as a _general_, what was at first too
 hastily concluded to be an _absolute_ rule.

 That the great majority of instances in which Vaccination has afforded
 perfect security against any future attack of Small Pox, fully warrants
 this conclusion, the results already detailed are sufficient to prove.
 What proportion these cases bear to the comparatively few, wherein the
 protection has been less perfect, it will not be possible to discover,
 because we are unable to ascertain how many hundreds of thousands or
 millions have passed through the vaccinating process. But little
 difficulty would be encountered, however, in ascertaining the full
 amount of the few who have had any thing bearing the slightest
 resemblance to an attack of Small Pox after Vaccination: these, for the
 most part, have been carefully recorded, and a degree of importance has
 certainly been attached to them greater than is warranted, either by
 their number, their severity, or their results.

 It is of still more importance, however, to know, that when Small Pox
 has occurred after Vaccination, it has been so essentially altered in
 the severity of its symptoms, and in the degree of danger arising from
 it, as to have rendered it entirely harmless in almost every instance;
 and although fatal cases have taken place in a few insulated and
 peculiar examples, they have been very much more rare than those which
 have occurred in consequence of inoculated, or even of secondary Small
 Pox. Sir Gilbert Blane, after describing (p. 10-11) the mild character
 of the disease as occurring after Vaccination, continues thus—“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 have occurred in a few instances; nay, there seems
 sufficient evidence that it actually has; but then 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 (the Medical
 and Chirurgical) 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_.” And Dr. Thomson tells us (Historical Sketch, &c. p.
 279), that “since the publication of my ‘Account of the Varioloid
 Epidemic,’ I have seen above _two hundred_ additional examples of Small
 Pox in Edinburgh, making in all _eight hundred and thirty-six_ cases of
 this disease, which have come under my observation since June, 1818. Of
 the whole number, _two hundred and eighty-one_ have occurred in
 individuals who had neither had Small Pox nor Cow Pox, and of these
 fully more than _one_ in _four_ died; _seventy-one_ had previously
 passed through _Small Pox_, and of these _two_ have died; and _four
 hundred and eighty-four_ had undergone the process of _Vaccination_,
 and of this number _one_ only died; results (adds Dr. Thomson) which
 evince, beyond the power of cavil, the beneficial effects of
 Vaccination in protecting the human constitution from the dangers of
 Small Pox, and the great advantages which must ultimately arise from
 the universal adoption of this practice.”—Perhaps the most fatal
 epidemic Small Pox, which has occurred of late years, was that which
 took place at Norwich in 1819. A history of it was published in the
 following year by Mr. Cross, and the general result was in perfect
 accordance with Dr. Thomson’s experience of the epidemic at Edinburgh.

 Mr. Cross relates that _two_ deaths only took place after Vaccination,
 and justly observes, that “these can have no weight against the
 practice of Vaccination compared with 10,000 vaccinated individuals,
 living in the midst of a contaminated atmosphere; with 530 deaths among
 little more than 3000 who had neglected to be vaccinated; and with the
 occasional occurrence of regular Small Pox in those who formerly had
 the disease.” Of the 10,000 persons thus protected by Vaccination, the
 Reviewer of Mr. Cross’s History, &c. observes (Edin. Med. and Sur.
 Journal, Vol. xvii. p. 127), “Had these persons been protected by
 variolous (Small Pox) inoculation, conducted in the best manner, and in
 the most favourable circumstances, at least 33 of them (1 in 300) would
 have died of the process intended to protect them; so that in comparing
 the advantages of the two methods of protection, we have to weigh 33
 deaths _certain_, against _two contingent on the invasion of an
 epidemic Small Pox_, and then we have to consider, whether there might
 not be nearly as great a chance of _two persons_ out of 10,000
 inoculated for Small Pox, taking a fatal Small Pox on exposure, at a
 subsequent period of life, to a virulent contagion.” I shall conclude
 the evidence I think it necessary to bring forward on this part of my
 subject with the following extract from the Report of the National
 Vaccine Establishment for 1820. In reference to the occasional cases
 wherein the protection from Vaccination is not quite complete, the
 Board observes,—“Yet the value of this important resource is not
 disparaged in our judgment; for after all, these cases bear a very
 small proportion to the number of those who are effectually protected
 by it. The reports of the Vaccinators at the several stations in the
 metropolis, give only _eight_ cases of Small Pox out of nearly 67,000
 vaccinated by them, since the first establishment of this board; and as
 the Small Pox has prevailed extensively in London, these persons so
 vaccinated, must have been frequently exposed to contagion, and
 consequently the protecting effect of Vaccination must have been
 submitted to as severe a test as can well be imagined. Moreover, we
 have the most undoubted proofs from experience, that where Vaccination
 has been performed perfectly, Small Pox, occurring after it, is almost
 universally a _safe_ disease; and though ushered in by severe symptoms,
 has hardly ever failed to be cut short before it had reached that
 period at which it becomes dangerous to life.”

 I shall not weaken the force of this evidence by entering into any
 minor question connected with this great subject—such as the
 probability of many of those, in whom Small Pox has succeeded to
 Vaccination, having passed through the latter process imperfectly,
 either in consequence of the matter employed not having been genuine;
 of the constitution not having shown adequate signs of being properly
 influenced by the process; or of the latter having been interfered with
 in its progress, by the accidental injury of the pustules, &c. No doubt
 all these causes may have had some effect, in consequence of the
 carelessness of parents, or of the practice of non-professional
 inoculators: in a matter of so much importance then, it behoves parents
 to guard against these causes of failure, which it is now certainly
 within the power of the poorest to do. Nor shall I detail the arguments
 by which Professor Thomson has rendered it probable that the pustular
 eruption, which has been so long known in this country under the name
 of Chicken Pox, is very nearly related to Small Pox itself, and is in
 reality the effect of the same infectious virus modified by various
 incidental circumstances; such as season of the year, the previous
 existence of Small Pox or of Cow Pox in those affected by it, or some
 peculiarity in their constitution not sufficiently obvious to be
 recognised by our senses. When I rest my proof of the power of
 Vaccination over the destructive consequences of Small Pox on the
 results which have been detailed, I am satisfied that it is fixed upon
 a basis too firm to be shaken by argument, and which will long outlive
 the feeble attacks of ignorance or prejudice.

------------------------------------------------------------------------




                              CONCLUSION.


 The following are the important conclusions which may obviously be
 deduced from the satisfactory evidence which has been detailed.

 1. That Vaccination has, within the space of twenty-five years, been
 the direct means of preserving, within the London[8] Bills of Mortality
 alone, a number of lives amounting to 21,127; and that if we extend the
 ratio of calculation to the whole of Great Britain and Ireland, it will
 appear that not fewer than 393,356 lives have been saved by this most
 valuable discovery, while an equal number have been preserved from
 “blindness, deformity, scrofula, or broken constitutions.”

-----

Footnote 8:

   The following is extracted from the London Medical and Physical
   Journal for the present month (December):—“_Influence of Vaccination
   upon the mortality of Berlin._ M. Casper has published a long paper,
   containing many curious details relative to the above subject; but we
   can do no more, at present, than give the result of his
   investigations. 1. The Small Pox formerly carried off from the 12th
   to the 10th of the population. 2. Formerly, at Berlin, one out of
   twelve children born, died of the Small Pox; now the deaths from the
   same cause are 1 in 116.”—_Journal Comp. September._ In London, as
   has been already shown, the number of deaths from Small Pox has been
   diminished from 1 in 10 to 1 in 28. It is obvious, therefore, that,
   were Vaccination employed in the latter city to the same proportional
   extent as at Berlin, a further saving of more than 500 lives annually
   would be effected, within the bills of mortality.

-----

 2. That in accomplishing this result, Vaccination has acted in two
 ways,—1. by superseding the practice of inoculation for Small Pox,
 which (while it afforded a certain degree of security to the
 inoculated) has been proved to have materially increased the gross
 number of deaths, by creating, artificially, many new sources of
 infection,—and, 2. by rendering the vaccinated entirely insusceptible
 of Small Pox infection, or the disease produced by it, in almost every
 instance, mild, harmless, and devoid of danger.

 3. That Vaccination is capable, if universally employed, of
 exterminating the Small Pox altogether, as has been proved by the
 experience of other countries.

 That Vaccination is a process perfectly unattended with danger to the
 individual who passes through it, and incapable of communicating any
 noxious infection to those around him, are facts too well known and too
 generally admitted, to require more than a passing notice; nevertheless
 it is essential that they should not be lost sight of.

 But if these be indeed plain and legitimate conclusions from the facts
 and arguments which have been adduced—and to myself they appear
 irresistible ones—then must Vaccination cease to be considered as a
 matter of policy, or of curious medical research only, for it plainly
 resolves itself into a momentous moral question. Let it once be
 admitted that it is capable of eradicating so great an evil as the
 infection of Small Pox, and it becomes the imperative duty of every
 individual to promote, to the utmost of his ability, an end so
 infinitely desirable. The question involves consequences so closely
 connected with the well-being of individuals and of society in general,
 and the actual existence of so many thousands annually, that ignorance,
 or doubt, will scarcely form an admissible apology for the omission of
 what is alike essential for private and for public security. If then
 any be ignorant on this momentous subject, let him not delay to obtain
 information; if any doubt, let him use every exertion to satisfy
 himself. If he hesitate to confer on his children the advantages, which
 Vaccination has been proved to be capable of bestowing, let him
 remember, that it has already been the means of preserving nearly four
 hundred thousand of his countrymen, and that, perhaps, he owes his own
 existence at this day, to its salutary influence; that but for
 Vaccination he might possibly himself, long ago, have fallen a
 sacrifice to the destructive disease from which it has rescued so many
 victims, and have been equally unable to call its efficacy in question,
 or to assist in consummating the grand object, which by means of it
 alone, appears capable of being accomplished.

 It was in our own country, that this most remarkable discovery
 originated; it was our own countryman, who, with such noble
 disinterestedness, as soon as he had satisfied himself of its real
 value, disclosed it to the world, and who sacrificed every personal
 consideration of pecuniary gain, to the general welfare of mankind. As
 Englishmen, we have just cause to be proud of both—the discovery and
 the discoverer; but we may well feel humbled when we remember, that the
 merits of neither have been adequately acknowledged amongst us; and
 that while the latter has been more justly estimated and more highly
 honoured in almost every other part of the world, the former has also
 been more effectively employed, and with proportionally more decisive
 results.

 It is true, that in some of the continental nations, where Vaccination
 has been most extensively and successfully employed, it has been made a
 matter of state policy, and legislative measures have been used to
 enforce its adoption; while, at home, it has rested with the public to
 adopt or reject it, as might be agreeable to their opinions or
 prejudices. Some writers have proposed that a similar mode of enforcing
 its general employment in England, by legislative compulsion, should be
 made use of; but, I conceive, such measures would be too little in
 accordance with the spirit of our government, and too repulsive to the
 feelings of Englishmen, to render them advisable, notwithstanding the
 paramount national importance of the object. That the time will
 presently arrive when this object will be fully accomplished, without
 any such unpalatable interference of the legislature, but by the
 irresistible force of truth alone, on the minds of the public, I cannot
 permit myself to doubt. Means of information on the subject, ample and
 satisfactory, are within the reach of all who are anxious to enquire;
 and it cannot be that they should long remain unexplored, or that they
 will fail to carry conviction to the mind of every candid and
 intelligent enquirer. But, when I reflect that the early conviction of
 a single individual, who entertains a doubt of the protective efficacy
 of Vaccination, or a prejudice against the practice, may be the direct
 or indirect means of saving the lives of many, I cannot refrain from
 most earnestly exhorting every one to consider this subject maturely—to
 be strenuous and unremitting in his enquiries respecting it, until
 every doubt is satisfied. He will then see one straight forward path of
 duty before him, which he will feel himself compelled, by every moral
 and religious obligation, most perseveringly and undeviatingly, to
 pursue. He will feel that his own personal exertions, in promoting the
 general use of Vaccination in his own family, amongst his dependents
 and all those whom he can in any the slightest degree influence, are
 essential to the accomplishment of the great philanthropic end
 proposed—the total extinction of Small Pox: a consummation that would
 prevent a larger portion of human misery, and preserve a larger number
 of human lives, than any other which it is in the power of imagination
 to conceive, or of reason to contemplate.

------------------------------------------------------------------------




                                TABLE I.

 The first column of this Table exhibits the total number of deaths,
     and the second column the number of deaths from Small Pox,
     occurring within the London Bills of Mortality, during every
     successive year, for a period of 121 years.


                   ┌───────┬──────────┬────────────┐
                   │       │  _Total  │ _Number of │
                   │_Year._│number of │deaths from │
                   │       │ deaths._ │Small Pox._ │
                   ├───────┼──────────┼────────────┤
                   │ 1703  │    20,720│         898│
                   │ 1704  │    22,684│       1,501│
                   │ 1705  │    22,097│       1,095│
                   │ 1706  │    19,847│         721│
                   │ 1707  │    21,600│       1,078│
                   │ 1708  │    21,291│       1,687│
                   │ 1709  │    21,800│       1,024│
                   │ 1710  │    24,620│       3,138│
                   │ 1711  │    19,833│         915│
                   │ 1712  │    21,198│       1,943│
                   │ 1713  │    21,057│       1,614│
                   │ 1714  │    26,569│       2,810│
                   │ 1715  │    22,232│       1,057│
                   │ 1716  │    24,436│       2,427│
                   │ 1717  │    23,446│       2,211│
                   │ 1718  │    26,523│       1,884│
                   │ 1719  │    28,347│       3,229│
                   │ 1720  │    25,454│       1,440│
                   │ 1721  │    26,142│       2,375│
                   │ 1722  │    25,750│       2,167│
                   │ 1723  │    29,197│       3,271│
                   │ 1724  │    25,952│       1,227│
                   │ 1725  │    25,523│       3,188│
                   │ 1726  │    29,647│       1,569│
                   │ 1727  │    28,418│       2,370│
                   │ 1728  │    27,810│       2,105│
                   │ 1729  │    29,722│       2,849│
                   │ 1730  │    26,761│       1,914│
                   │ 1731  │    25,262│       2,640│
                   │ 1732  │    23,358│       1,197│
                   │ 1733  │    29,233│       1,370│
                   │ 1734  │    26,062│       2,688│
                   │ 1735  │    23,538│       1,594│
                   │ 1736  │    27,581│       3,014│
                   │ 1737  │    27,823│       2,084│
                   │ 1738  │    25,825│       1,590│
                   │ 1739  │    25,432│       1,619│
                   │ 1740  │    30,811│       2,725│
                   │ 1741  │    32,169│       1,977│
                   │ 1742  │    27,483│       1,429│
                   │ 1743  │    25,200│       2,029│
                   │ 1744  │    20,606│       1,639│
                   │ 1745  │    21,296│       1,206│
                   │ 1746  │    28,151│       3,236│
                   │ 1747  │    25,494│       1,380│
                   │ 1748  │    23,869│       1,789│
                   │ 1749  │    25,516│       2,625│
                   │ 1750  │    23,727│       1,229│
                   │ 1751  │    21,028│         998│
                   │ 1752  │    20,485│       3,538│
                   │ 1753  │    19,276│         774│
                   │ 1754  │    22,696│       2,359│
                   │ 1755  │    21,917│       1,988│
                   │ 1756  │    20,872│       1,608│
                   │ 1757  │    21,313│       3,296│
                   │ 1758  │    17,576│       1,273│
                   │ 1759  │    19,604│       2,596│
                   │ 1760  │    19,830│       2,187│
                   │ 1761  │    21,083│       1,525│
                   │ 1762  │    26,326│       2,743│
                   │ 1763  │    26,143│       3,582│
                   │ 1764  │    23,202│       2,382│
                   │ 1765  │    23,230│       2,498│
                   │ 1766  │    23,911│       2,334│
                   │ 1767  │    22,612│       2,188│
                   │ 1768  │    23,639│       3,028│
                   │ 1769  │    21,847│       1,968│
                   │ 1770  │    22,434│       1,986│
                   │ 1771  │    21,780│       1,660│
                   │ 1772  │    26,053│       3,992│
                   │ 1773  │    21,656│       1,039│
                   │ 1774  │    20,884│       2,479│
                   │ 1775  │    20,514│       2,669│
                   │ 1776  │    19,048│       1,728│
                   │ 1777  │    23,334│       2,567│
                   │ 1778  │    20,399│       1,425│
                   │ 1779  │    20,420│       2,493│
                   │ 1780  │    20,517│         871│
                   │ 1781  │    20,709│       3,500│
                   │ 1782  │    17,918│         636│
                   │ 1783  │    19,020│       1,550│
                   │ 1784  │    17,828│       1,759│
                   │ 1785  │    18,919│       1,999│
                   │ 1786  │    20,454│       1,210│
                   │ 1787  │    19,349│       2,418│
                   │ 1788  │    19,697│       1,101│
                   │ 1789  │    20,749│       2,077│
                   │ 1790  │    18,038│       1,617│
                   │ 1791  │    18,760│       1,747│
                   │ 1792  │    20,213│       1,568│
                   │ 1793  │    21,749│       2,382│
                   │ 1794  │    19,241│       1,913│
                   │ 1795  │    21,179│       1,040│
                   │ 1796  │    18,905│       3,548│
                   │ 1797  │    17,014│         522│
                   │ 1798  │    18,155│       2,237│
                   │ 1799  │    18,134│       1,111│
                   │ 1800  │    23,068│       2,409│
                   │ 1801  │    19,374│       1,461│
                   │ 1802  │    19,379│       1,579│
                   │ 1803  │    19,582│       1,202│
                   │ 1804  │    17,038│         621│
                   │ 1805  │    17,565│       1,685│
                   │ 1806  │    17,938│       1,158│
                   │ 1807  │    18,334│       1,297│
                   │ 1808  │    19,954│       1,169│
                   │ 1809  │    16,680│       1,163│
                   │ 1810  │    19,893│       1,198│
                   │ 1811  │    17,043│         751│
                   │ 1812  │    18,295│       1,287│
                   │ 1813  │    17,322│         898│
                   │ 1814  │    19,783│         638│
                   │ 1815  │    19,560│         725│
                   │ 1816  │    20,316│         653│
                   │ 1817  │    19,968│       1,051│
                   │ 1818  │    19,705│         421│
                   │ 1819  │    19,228│         712│
                   │ 1820  │    19,348│         792│
                   │ 1821  │    18,451│         508│
                   │ 1822  │    18,863│         604│
                   │ 1823  │    20,587│         774│
                   └───────┴──────────┴────────────┘

------------------------------------------------------------------------




                               TABLE II.

 This Table is divided into intervals of five years each. It
     embraces the same period of 121 years, included in the former,
     and is intended to shew the encrease in the average amount of
     mortality from Small Pox during the practice of Inoculation,
     and the striking diminution which has taken place since the
     introduction of Vaccination.


  ┌────────────────┬──────────┬────────────┬────────────┬───────────┐
  │                │  _Total  │ _Number of │ _Number of │ _Relative │
  │ _Periods of 5  │number of │deaths from │deaths from │ number of │
  │years including_│ deaths._ │Small Pox._ │Small Pox in│deaths from│
  │                │          │            │   1000._   │Small Pox._│
  ├────────────────┼──────────┼────────────┼────────────┼───────────┤
  │  1703 to 1707  │   106,948│       5,293│        49.4│1 in 20.2  │
  │  1708 -- 1712  │   108,742│       8,707│        80.0│1 in 12.4  │
  │  1713 -- 1717  │   117,740│      10,119│        85.9│1 in 11.6  │
  │  1718 -- 1722  │   132,216│      11,095│        84.5│1 in 11.9  │
  │  1723 -- 1727  │   138,737│      11,625│        83.6│1 in 11.9  │
  │  1728 -- 1732  │   132,913│      10,705│        80.5│1 in 11.4  │
  │  1733 -- 1737  │   134,237│      10,750│        80.0│1 in 12.4  │
  │  1738 -- 1742  │   141,720│       9,415│        66.0│1 in 15.0  │
  │  1743 -- 1747  │   120,753│       9,484│        78.0│1 in 12.7  │
  │  1748 -- 1752  │   114,625│      10,179│        89.0│1 in 11.2 ⎫│
  │  1753 -- 1757  │   106,074│      10,025│        95.0│1 in 10.5 ⎪│
  │1758 single year│    17,576│       1,273│        72.4│1 in 13.8 ⎪│
  │  1759 -- 1763  │   112,986│      12,633│       111.8│1 in  8.9 ⎪│
  │  1764 -- 1768  │   116,594│      13,630│       116.9│1 in  8.5 ⎪│
  │  1769 -- 1773  │   113,770│      10,645│        93.5│1 in 10.6 ⎬│
  │  1774 -- 1778  │   104,179│      10,808│       103.7│1 in  9.7 ⎪│
  │  1779 -- 1783  │    98,584│       9,050│        91.7│1 in 10.8 ⎪│
  │  1784 -- 1788  │    96,247│       8,487│        88.2│1 in 11.3 ⎪│
  │  1789 -- 1793  │    99,509│       9,391│        94.3│1 in 10.5 ⎪│
  │  1794 -- 1798  │    94,494│       9,260│        96.9│1 in 10.2 ⎭│
  │  1799 -- 1803  │    99,537│       7,762│        77.9│1 in 12.8 ⎫│
  │  1804 -- 1808  │    90,829│       5,930│        65.3│1 in 15.3 ⎪│
  │  1809 -- 1813  │    89,233│       5,299│        59.3│1 in 16.8 ⎬│
  │  1814 -- 1818  │    99,332│       3,488│        35.1│1 in 28.4 ⎪│
  │  1819 -- 1823  │    96,477│       3,390│        35.1│1 in 28.4 ⎭│
  └────────────────┴──────────┴────────────┴────────────┴───────────┘

 The first Bracket includes the period when Inoculation for Small Pox
 was in most general use. The second Bracket the period of Vaccination.

------------------------------------------------------------------------




       _Lately was published by the same Author, and to be had of
                         E. Charnley, Price 1s._


                                  HINTS

                       TOWARDS THE ADOPTION OF AN

                   IMPROVED PRINCIPLE OF REMUNERATING

                         The Surgeon Apothecary,

                                   OR,

                    GENERAL PRACTITIONER IN MEDICINE.

                            ADDRESSED TO THE

                        MEMBERS OF THE PROFESSION

                                 AND THE

                            PUBLIC AT LARGE.

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

------------------------------------------------------------------------

                           Transcriber’s note:

 Page 4, ‘in-instances’ changed to ‘instances,’ “where three instances
 had occurred”

 Page 14, ‘recal’ changed to ‘recall,’ “who cannot recall many more”

 Page 24, double quote moved to after ‘advantages,’ “of some real
 advantages” (p. 59).”

 Page 25, double quote inserted after ‘are,’ “words are” (p. 37),”

 Page 59, double quotes added after ‘results’ and before ‘which,’
 “results” (adds Dr. Thomson) “which evince”

 Page 73, full stop inserted after table heading ‘Year.’

 Page 74, ‘8817’ changed to ‘1788,’ “1788     19,697     1,101”