VACCINATION ***


                                   A

                          STATEMENT OF FACTS,

                               TENDING TO

                ESTABLISH AN ESTIMATE OF THE TRUE VALUE

                                  AND

                             PRESENT STATE

                                   OF

                              VACCINATION.

                               ----------

                      BY SIR GILBERT BLANE, BART.

  _F.R.S. of London, Edinburgh, and Göttingen; Member of the Imperial
  Academy of St. Petersburgh; and Physician in Ordinary to the King._

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

 FROM THE TENTH VOLUME OF THE MEDICO-CHIRURGICAL TRANSACTIONS, PUBLISHED
            BY THE MEDICAL AND CHIRURGICAL SOCIETY OF LONDON;

                            WITH ADDITIONS.

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

                                LONDON:

       PRINTED FOR THOMAS AND GEORGE UNDERWOOD, 32, FLEET STREET.

                               ----------

                                 1820.

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

                   J. MOYES, GREVILLE STREET, LONDON.

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

                                   A

                          STATEMENT OF FACTS,

         TENDING TO ESTABLISH AN ESTIMATE OF THE TRUE VALUE AND
                            PRESENT STATE OF

                              VACCINATION.

              BY SIR GILBERT BLANE, BART. F.R.S. Lond. &c.

                  _Physician in Ordinary to the King._

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

                         _Read Nov. 10, 1819._

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

It is now twenty-one years since Vaccination was promulgated in this
country by Dr. Jenner, and fifteen years since it began to produce a
sensible effect in diminishing the mortality from Small Pox. In regard
to the latter period, it is coeval with this Society; yet, though no
discovery in nature nor in medicine has been more important to the
interests of humanity, nor any which has ever so rapidly and universally
won the assent and practical adoption of mankind, there are no notices
of it on our records, except in our second volume, in an article by Dr.
Bateman, in which he relates a case of a mother who was affected with
the Small Pox a second time, by being exposed to infection, from some of
her own children who had caught it casually; while her other children,
who had been vaccinated, resisted it. As it is to be hoped that our
labours will prove to posterity some of the principal sources of
reference regarding the medical and chirurgical discoveries and
improvements of the age; as it is one of the reproaches of our country,
that it has not availed itself so much as any other of the benefits of
Vaccination; and as there are writers among us who still allege that the
failures are so numerous that the value of the discovery is very
ambiguous, it seems one of the duties of the Society to lend its aid in
placing these important points in their true light.

It seems almost needless to premise, that the Small Pox is of all
maladies that, which, during the last thousand years, has destroyed the
largest portion of the human species, and been productive of the largest
share of human misery. There is, perhaps, no disease over which medical
art has less power; and this power, such as it is, has consisted more in
abolishing pernicious practices, than in ascertaining any positive
methods of controlling its fatality, unless we except the inoculation of
it with its own _virus_. But, though the beneficial effect of this on
those on whom it is actually practised is undeniable, it has no tendency
like Vaccination to extirpate the disease; and from the impossibility of
rendering it universal, it has actually been found to add to the general
mortality of Small Pox, by opening a new source for the diffusion of its
_virus_.

It ought to be stated also, with a view to a decision on this question,
that Vaccination itself is attended with no danger, and frequently takes
effect without any visible disturbance in the system. There is even
reason to believe, that in its process it wards off other diseases, by
pre-occupying the constitution.

In order to bring this matter to the test of calculation, in order also
to institute a comparison of the mortality of Small Pox as influenced by
Vaccination, as well as by Inoculation from itself, I have selected from
the bills of mortality four periods, each of fifteen years, for the
purpose of exhibiting the mortality of Small Pox in each of these series
in regard to each other. These are thrown into the form of Tables, and
annexed to this article.

The first series, is the fifteen years immediately preceding the
introduction of Inoculation; that is, from 1706 to 1720, both included.
Previous to this period, no account that could be depended upon
regarding the Small Pox, could be derived from the bills of mortality;
for down to the beginning of last century such was their imperfect
construction, that Small Pox, Measles, and Flux were blended under one
head. Exception may be taken against the accuracy of these bills, even
in this improved state, particularly with regard to the discrimination
of diseases. This objection, however, is certainly less applicable to
Small Pox than any other disorder, its character being so striking as
not to be mistaken by the most ignorant and careless observer.

The second series is taken at the middle of the last century, when
Inoculation had made considerable progress; that is, from 1745 to 1759,
both included. In comparing this with the preceding series, with regard
to absolute numbers, it ought to be taken into account, that eleven
parishes were added to the bills of mortality, between the years 1726
and 1745, both included: so that the progressive improvement of general
salubrity ought to be estimated still higher than what is indicated by
the diminished mortality, as it stands in the Tables.

The third series comprises the fifteen years previous to the
introduction of Vaccination, when Inoculation had made still greater
progress; that is, from 1785 to 1798, both included.

The fourth series comprises the time in which the vaccine Inoculation
has been so far diffused as to produce a notable effect on the mortality
of Small Pox; that is, from 1804 to 1818, both included.

The result of these computations stands as follows:—

     _Ratio of the Mortality of Small Pox to the total Mortality._

          From 1706 to 1720, one in 12.7; that is, 78 in 1000.
          From 1745 to 1759, one in 11.2; that is, 89 in 1000.
          From 1785 to 1798, one in 10.6; that is, 94 in 1000.
          From 1804 to 1818, one in 18.9; that is, 53 in 1000.

        Fractions are not noticed in the last column of numbers.

It appears from this statement, that the proportion of deaths from Small
Pox to the total mortality, increased in the course of last century; so
that Inoculation appears to have added to the mortality. It is but fair
to mention, however, that this total mortality is not quite a just scale
whereby to measure the relative mortality of Small Pox; for in the
course of that century, the general mortality itself was greatly
diminished in relation to the population. This diminution of general
mortality was chiefly owing to the diminished mortality of children
under two years of age, which, at the time when the account began to be
kept, 1729, averaged about 9000; but at the end of the century not more
than 5000[1]; also to the decrease of fevers, and still more of fluxes.
The relation of the mortality of Small Pox to the population, would
therefore be a more fair criterion of its increase or decrease. In this
view it might, at first sight, be thought that it had decreased; for the
population of the metropolis nearly doubled in the course of the last
century. But it is to be remarked, that there has been little increase
of population in that portion of the metropolis which is included in the
bills of mortality; the great increase having been in the parishes of
Mary-le-bone and St. Pancras, which are not included in these bills. It
is computed in the remarks subjoined to the last parliamentary returns
of population, that the population of London, within the walls, had
decreased more than three-fifths in the course of last century, from the
widening of streets, the erection of public buildings and warehouses,
and, it might have been added, from the migration of mercantile families
to the west end of the town. As a set-off to this, there has certainly
been a great addition, in the same time, to those parishes within the
bills, which stand on the verge of the metropolis, such as St. George’s
Hanover Square, St. George’s Bloomsbury, Poplar, and Stepney. But the
addition to the population, if any, within the bills of mortality, does
not seem to be so considerable as to affect the computation. And, if
this is admitted, the absolute numbers of the deaths from Small Pox,
estimated in relation to the population, that is, exactly as they stand
on the Tables, afford a fair comparative statement of the mortality in
the last century, and seem to prove that Inoculation has not added so
much to it as has been alleged. 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.

But the truly important result from these statements consists in the
clear, undeniable, and great diminution of it since the introduction of
Vaccination. It appears, that in the last fifteen years, the mortality
from Small Pox, in the bills of mortality, has not been much more than
one-half of what it was in the two like series of years in the middle
and latter end of the last century. Nor does this comprise the whole
benefit derived from this discovery in the metropolis; for, besides that
the sixth part of it lies without the bills, it was found, in levying
the tax on burials for the last six months of 1794, that the number of
unregistered deaths, chiefly those of dissenters, amounted in that half
year to 3148; and the reporter of the parliamentary enumeration thinks
that, as besides these there were undiscovered interments, the
unregistered deaths may be computed at one-third of the total mortality,
that is, about 7000. (_See Abstract of the Parish Registers, 1811,
printed by authority of Parliament, page 200._)

Assuming, therefore, that Vaccination had not been practised the last
fifteen years, and that the mortality from Small Pox, within the bills,
had in that time, that is, from 1804 to 1818, been the same as from 1784
to 1798, that is, 27,569 in place of 14,716; and assuming that there has
been the same proportional diminution of deaths in the districts without
the bills, and among the unregistered subjects, the account of lives
saved in this metropolis by Vaccination in the fifteen years, will stand
as follows:—

                 Within the bills of mortality  12,853
                 Without the bills of mortality  2,570
                 Unregistered cases              7,711
                                                ------
                                          Total 23,134

The first of these numbers is found by subtracting the amount of deaths
by Small Pox, in the bills of mortality, during the practice of
Vaccination, from the amount of them, during the same number of years,
immediately before the discovery of Vaccination.

The second number is found by dividing the first by 5. The population of
the metropolis without the bills is stated at one-sixth of the whole,
which is evidently one-fifth of that within the bills.

The third number is found by dividing the sum of the two others by 2;
the unregistered cases being, as before stated, one-third of the whole.

It appears, therefore, that, even under the very imperfect practice of
Vaccination which has taken place in this metropolis, 23,134 lives have
been saved in the last fifteen years, according to the best computation
that the _data_ afford. It will be seen, by an inspection of the Table,
that in that time there have been great fluctuations in the number of
deaths. This has been owing partly to the Small Pox Inoculation of
out-patients having, by an unaccountable infatuation, been kept up at
the Small Pox Hospital for several years after the virtue of Vaccination
had been fully confirmed. The greater number of deaths in 1805 may
chiefly be referred to this cause. Since the suppression of this
practice, the adoption of Vaccination, though in a degree so incomplete,
in consequence of public prejudice, created entirely by mischievous
publications, has been unable to prevent a considerable, though
fluctuating, mortality from Small Pox. The late mortality from Small
Pox, though little more than one half of what it was in former times,
might have been entirely saved, if Vaccination had been carried to the
same extent as in many cities and whole districts on the continent of
Europe, in Peru, and Ceylon.

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.

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[2]. 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 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.

It is farther manifest, that extirpation being the ultimate aim of this
discovery, and there being the fullest historical and practical evidence
of its being capable of accomplishing this end, all other questions with
regard to its expediency must be futile and irrelevant. It is in the
nature of all morbid phenomena to be liable to exception. One of the
most essential and characteristic laws of Small Pox itself, namely, that
of its affecting the human subject but once in life, is found in rare
cases to be violated. It is, therefore, perfectly conformable to
analogy, and naturally to be expected, that it may not in all cases be a
complete security against Small Pox. But it is obvious, that, admitting
these exceptions to be very frequent, much more so than the recurrence
of Small Pox after Small Pox, this can constitute no objection to the
practice, as long as the extirpating power remains unimpaired and
unimpeached. Nay, it is obviously so far from an objection, that it
ought to operate as a powerful additional incentive on every benevolent
mind, to push Vaccination to the utmost, as rapidly as possible, in
order that those who are still susceptible, either from peculiar natural
constitution, or from the unskillful manner of conducting the operation,
or from defective matter, may not, by any possibility, catch it; for, in
the event of its extirpation, it could nowhere be met with. And in order
to stimulate the good and the wise to aim strenuously at this
consummation, 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.

It is true that in its last visitation of this metropolis, one hundred
and fifty-four years ago, it carried off 70,000 victims in a few months;
but since that time, the deaths from Small Pox, recorded in the bills of
mortality, have amounted to more than 300,000; and a like number of the
survivors have been afflicted with blindness, deformity, scrofula, or
broken constitutions, which is not the case with the survivors of the
Plague. 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
the Small Pox. It is alleged by some of the soundest Political
Economists that Small Pox does not diminish the numbers of mankind, nor
Vaccination increase them; for population is determined by subsistence,
and the indefinite powers of procreation soon repair the ravages of
disease. But, however true this may be, the miseries incident to so many
of those who survive Small Pox, whereby they become a burden to
themselves, their families, and to society, render this disease
uncontrovertibly an evil of the first magnitude, not to mention the
intense sufferings and afflictions inseparable from it; and in this view
of the matter the objection seriously adduced against Vaccination by one
of its opponents[3], that _Small Pox is a merciful dispensation of
Providence for the poor man, by diminishing the burden of his family_,
will not hold good, for the burden is not removed.

And when it is considered that there are large portions of the globe,
India, China, even one whole quarter of it (North and South America),
besides all the tropical and arctic regions, in which the Plague has
never been known; and that in all the countries liable to it, it seldom
appears but at one season of the year, and in some at long intervals,
the ravage which it makes is trifling when compared with the unceasing
havoc of Small Pox, which spares no nation in any climate, or at any
season. Yet the Legislative Regulations for excluding and checking the
Plague are of the most harsh and despotic description, while the law
touches upon Small Pox comparatively with the most lenient hand. It
ought to be generally known, however, that in a late trial and
conviction, it was laid down by the judge to be the law of the land,
that a medical practitioner who neglects to exclude the person whom he
inoculates from communication with others, is liable to fine and
imprisonment. Morally considered, indeed, it is difficult to conceive a
higher degree of flagitious turpitude than that of a professional
person, in the present state of knowledge, exposing his
fellow-creatures, from sordid motives, to one of the most grievous
calamities of which human nature is susceptible.

The preceding reasoning is grounded on the supposition of extirpation:
but, however demonstrable the _possibility_ of extirpation may be, it
may not in all communities be _practicable_; and may not these alleged
failures so operate, as, in such circumstances, to render the expediency
of the practice questionable?

In order to decide this, let the nature and amount of these failures be
ascertained and estimated.

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

As it is of the utmost consequence to establish the strong and important
distinction between Small Pox, properly so called, and that which takes
place after Vaccination, which may be called the mitigated, or five day
Small Pox, a few of the most impressive testimonies respecting the safe
nature of the latter may be here recited. Mr. Brown[4], of Musselburgh,
gives the detail of forty-eight cases, in none of which did the
secondary fever nor death occur. Here was a saving of at least eight
lives, at the lowest computation; for this is the number which, by the
average mortality of natural Small Pox, would have died if the
constitutions of these forty-eight persons had not been modified by
previous Vaccination. Dr. Dewar, of Edinburgh, hearing that many
vaccinated subjects had been affected with Small Pox at Cupar in Fife,
where the natural Small Pox at the same time prevailed, he most laudably
repaired to the spot to investigate the subject. He found that
fifty-four vaccinated subjects had caught the Small Pox. All these,
except one, had the mitigated or five day eruptive fever, and livid. The
fatal case was that of a child, who had a complication of other
disorders, and having died on the fifth day, the Small Pox, according to
its ordinary course of fatality, could not of itself be the cause of
death. All the rest were safe; while of sixteen cases of the natural
Small Pox at the same time and place, six died; so that, if these
fifty-three cases had not undergone the mitigating process of
Vaccination, nineteen or twenty would have perished. Between thirty and
forty cases of the same kind have occurred at Carlisle, on the testimony
of Dr. Barnes, a respectable practitioner of that city[5]. Many proofs
might be adduced from the oral testimony of private practitioners, which
would overswell this article. The only other to be mentioned is from the
Report of the Central Committee of Vaccination at Paris, made in
December last, in which the description of the disease occurring after
Vaccination corresponds exactly with the mitigated five day cases which
have occurred in Britain. They refuse the name of Small Pox to it; but
as I know from my own observation, as well as from the testimony of
others, that the matter from it does by Inoculation give the Small Pox,
we can hardly, perhaps, with propriety deny it that name; but it should
be distinguished by some strong discriminating epithet, such as is
suggested above.

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

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

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

It is of the highest importance to society, that this subject should be
seen in its true light, and in all its bearings; for the frequent
occurrence of these cases of Small Pox, however safe in themselves, have
had a most pernicious effect on the credulous and ignorant, by giving a
check to the practice of Vaccination. It ought never to be forgot that
the power of Vaccination in extirpating Small Pox being established, the
question of its expediency is completely set at rest. How many parents
are there now who, from a weak distrust in the virtue of Vaccination,
have to lament the loss of a child from Small Pox, either casual or
inoculated? Many such are known to myself. It is pleasing, however, to
observe, that though this unmerited discredit into which Vaccination had
fallen, swelled the number of deaths in London from Small Pox to 1051 in
1817, good sense is likely still to prevail, for last year (1818) the
deaths have fallen lower than they have ever been known since the
institution of the bills of mortality, the total number being only
421[6].

On the whole matter, I believe I am speaking the language of every man
of good principles and feelings, capable of reflecting seriously and
considerately on the subject, when I say, that whenever he applies his
mind to it, he finds some new and increasing cause of complacency and
satisfaction. Viewed as a mere physical fact in the natural history of
the animal kingdom, the virtue of the vaccine _virus_ in resisting the
action of the _variolous_, is, by its novelty and singularity, highly
striking and interesting to every one whose taste leads him to take
delight in contemplating and exploring the devious ways and varied forms
of Nature, as curious exceptions to the uniformity and constancy of her
laws. One can hardly contemplate with sufficient astonishment, the
extraordinary fact that a morbid poison taken from a domestic animal
should, when inserted into the human body, shield it against the assault
of one of the most fatal and cruel maladies to which it is incident. But
the importance of this, as a physical curiosity, vanishes to nothing
when the unexampled benefits of it to mankind are fairly weighed;
benefits which could never have been dreamt of by the most sanguine
philanthropist, who, in contemplating it, finds himself lost in
astonishment, at a boon to mankind almost beyond the grasp of his mind
duly to appreciate: so that what seems at first sight merely a sportive
aberration from the usual course of things, has, by the wise
dispensation of Providence, become subservient to the most beneficent
purposes: and how many more useful discoveries may there yet be in
reserve for the alleviation of human misery, from obscure and undetected
facts still lurking under the very surface of Nature! It will in the
eyes of future ages be deemed an _epocha_ in the destinies of the world,
and one of the highest boasts of the country in which it took its rise,
with a sense of unrequitable obligation to the individual[7] who first
disclosed and promulgated the secret, by drawing it from the dark
recesses of rural tradition, and rendering it available to the whole
human race.

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

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

                                TABLE I.

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

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

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

                               TABLE II.

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

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

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

                               TABLE III.

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

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

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

                               TABLE IV.

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

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

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

                                LONDON:

                 PRINTED BY J. MOYES, GREVILLE STREET.

-----

Footnote 1:

  This diminished mortality of young children is, like that of fevers
  and fluxes, owing chiefly to the improvements in ventilation and
  cleanliness, but greatly also to laying aside the custom of exposing
  them to the open air in winter and early in spring; either from
  inadvertency, or from the false notion of rendering them hardy,
  whereas they thereby catch inflammations of the lungs. Nothing tends
  more to the health, strength, and growth of children, than genial
  warmth. It seems chiefly owing to the great plenty and cheapness of
  fuel, that the race of people in Lancashire are so superior in their
  form and size. In Buckinghamshire, on the contrary, where fuel is
  extremely scanty and dear, the race of people is small and puny,
  insomuch that it is provided by Act of Parliament that men shall be
  admitted into the militia of a smaller stature in this than other
  counties.

Footnote 2:

  See Pfaff Neuen Nord v. Archiv. B. I.

Footnote 3:

  See Serious Reasons for uniformly opposing Vaccination. By John Birch.
  London, 1807.

Footnote 4:

  See Inquiry into the Antivariolous power of Vaccination. Ed. 1809.
  There is an article in the Edinburgh Medical Journal by the same
  gentleman in 1819, in which he mentions that he had heard of several
  deaths having occurred from cases of Small Pox after Vaccination. But,
  admitting this, it is utterly incomprehensible by what process of
  reasoning Mr. Brown could on such premises arrive at the conclusion
  that Vaccination ought to be exploded and abandoned.

Footnote 5:

  See also a clear and able exposition of this subject in the Medical
  and Surgical Journal of Edinburgh for July, 1818, by Mr. Dunning, of
  Plymouth.

Footnote 6:

  Since the first publication of this Tract, it has appeared that in the
  succeeding year (1819), the deaths from the Small Pox had advanced to
  712; which ought to add to the perseverance, zeal, and vigilance, of
  the friends of humanity in prosecuting Vaccination.

Footnote 7:

  Dr. Edward Jenner.

                  *       *       *       *       *

                          Transcriber’s Notes

Some inconsistencies in spelling, hyphenation, and punctuation have been
retained.

This file uses _underscores_ to indicate italic text.