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of several chronic diseases, and to be therefore in the highest degree objectionable. This charge can only be substantiated by an appeal to facts; what they do these testify? Have chronic cutaneous eruptions (the disorders alleged to be the consequences of vaccination) recently been on the increase ? All medical records and reports, presented to the world for the last twenty years, agree in the diminution rather than the augmentation, both of the number and severity of the complaints in question; and what may be considered as decisively to the point, is the following statement from a respectable surgeon to the Infirmary at Gloucester :
• A more healthy description,' says this gentleman, of human beings does not exist, nor one more free from chronic cutaneous impurities, than that which suffers most from cow-pox, by reason of their being employed in dairies; and the Gloucester Infirmary, one of the largest provincial hospitals, is situated in a county in which accidental cow-pox has been prevalent from time immemorial ; many hundreds among the labouring people have had the cow-pox since the establishment of that institution, and that more severely than is generally the case in artificial vaccination, and yet not a single patient has applied to the Infirmary in half a century for the relief of any disease, local or constitutional, which he or she imputed, or pretended to trace to the cow-pox : and let it be repeated and remembered, that the artificial in no respect differs from the natural, except in being generally less virulent.
This document, backed by the concurrent testimony of impartial and unprejudiced records from medical observers, that scrophulous and cutaneous affections are (as we have said) upon
the decline, will, it is presumed, serve as a sufficient refutation of those partial and garbled statements which in the early stages of the controversy were made for the purpose of confirming the apprehensions of the timid, and giving strength to ungrounded prejudices. The question therefore of vaccine efficacy remains unincumbered by minor considerations, and ii is now for us finally to observe upon the evidence by which the following proposition has been maintained, viz. that the vaccinated and the inoculated child stand upon precisely the same fooiing in respect of security against small-pox.
In spite of our professions of impartiality, we suspect that our readers have by this time set us down as determined defenders of the vaccine cause. We shall probably, therefore, excite some surprise by expressing it as our opinion, that the absolute truth of the above proposition does not appear to us to have been hitherto fairly established. It does, we confess, seem probable that there may be a shade of difference in the preventive efficacy of the vaccine and variolous virus ; even this, however,
we must allow to the advocates of vaccination, has not been proved, and we hasten to adduce the evidence on either side.
Mr. Moore, who is a professed partizan of vaccination, argues for its identity as to effect on the ground of analogy, and contends that the exercise of the virus of only a partially preventive power would be an anomaly in pature. This argument is in itself forcible, and is managed by our author with considerable adroitness. It is needless, however, to remark, that it must fall powerless even out of Mr. Moore's hands unless backed by actual observation : the preventive efficacy of vaccination is a question not of theory but of fact. That there have happened cases of small-pox of an indisputable nature, subsequently even to proper vaccination, no one can deny; but then it is urged that small-pos has likewise been known to occur twice to the same individual, and to have succeeded to inoculation in the same manner as it has to vaccination. The point, however, at issue is whether these anomalies are proportionately as frequent in the latter as in the former case; and, in determining this, Mr. Moore contends that the comparative estimates have not been made with due attention to every necessary particular.
• In making this estimate,' he says, ' an error has been committed by comparing the results of the primary practice of vaccination with those of the most approved state of variolous inoculation, forgetting that, when the latter operation was introduced, failures of every kind were far more frequent than of late, and that even the deaths amounted in early practice to one in fifty. In like manner, vaccination, on its first introduction, was so misconducted, that two children in a workhouse were actually destroyed by it, although, when skilfully practised, it is really less dangerous than opening a vein or cutting a corn. A multitude of lesser mistakes were then committed by the ablest men in the profession, who, deceived by analogy, imitated too nearly the plan of the small-pox inoculation; and many were not sufficiently aware either of the deterioration to which vaccine lymph is subject, or of the mischiefs which arise even when the lymph is pure from the vaccine process being interrupted or disturbed by violence, or by disease. The number of failures from all these sources of error in early pracyce has been considerable; it is therefore too soon at present to compute and compare the number of cases in which small-pox has occurred after inoculation and vaccination.'
We are not sure whether this be not rather too much in the spirit of a systematic advocate. Mr. Moore talks of failures from inoculation when first practised being one in fifty; but it ought to be recollected that such failures were rather referable to the mode of communicating and managing the disease, than to the occurrence of any second affection. Now the case is far different with vaccination; for although two children in a workhouse were actually deVOL. XIX. NO. XXXVIII.
stroyed by it,' these instances stand almost alone in the records of the practice; and, however inefficiently the process may have been performed by the several vaccinators who have undertaken the task without being qualified for the office, we do not hear, excepting from the most prejudiced and partial quarters, that any positive injury was ever inflicted on the children thus ineffectually ope
The best stand which the vaccinists can make on the ground of comparative estimates, is that of the immense multitudes which have undergone the process since the commencement of vaccination, compared with those subjected to inoculation in the same number of years from its primary establishment. When we hear of one case after another, therefore, of small-pox subsequent to cow-pox, it may be replied, that bad as many children been inoculated, in place of being vaccinated, the instances of failure would be equally
Whether such position would be correct can scarcely be ascertained, since there is no register of the number of failures in either case, and without it no actual calculation can be made. We have, however, been just favoured with a document from the Small-pox Hospital, which, in connection with the remarks that accompany it, is highly favourable to the vaccine cause; and let it be recollected that these remarks come from one who so far from having been an enthusiast ab origine in the cause of cow-pox, has been accused by his contemporaries of being a covert enemy to its
! Every passing month,' says Dr. Adams, physician to the Institution just named,' serves to convince me of the absolutely preventive power of vaccination when properly conducted. Not very long since, my observations led me to the inference that the efficacy of inoculation, when compared with vaccination, or rather the probability of failures from one and the other, stood at about the proportion of 1200 to 1000; but I am now, to say the least, inclined to the inference, that both, when properly managed, are equally efficacious; and that the instances of failure we hear of, are either to be accounted for by the very large numbers that have been vaccinated, or by the process having been inefficiently performed.
Such are the opinions of the privcipal officer, not of a Vaccine establishment, but of the Small-pox Hospital, where, if in any place, failures are likely to be heard and complained of. The document to which we have alluded, is a statement of the numbers inoculated, vaccinated, and admitted with the natural small-pox during the last seven years. The numbers inoculated, it will be observed, are marked admitted;' since the laws of the institution require that those individuals, who are inoculated, shall not leave the hospital till the fear of infection is over.
Admitted for Admitted for Inoculation. Vaccinated.
natural Small-poxa 1811
69 . 1814
160 The reader who shall cast his eye over the above table will perceive that the numbers of vaccinated subjects have been very much increased during the three preceding years; and that the numbers of cases of natural small-pox have been likewise, during the same period, more numerous than before; the chances, then, of failure in both ways, that is, both from the increased prevalence of smallpox infection, and the increased number of vaccinated subjects must have been considerably multiplied; and yet we are told by the medical officers of the Institution, that such failures are decidedly and very materially upon the decrease; and let it be again remarked, that such statement comes from gentlemen whose minds, if they were likely to be biassed in any way, would rather bend towards the side of inoculation.
But, on the other hand, we hear of small-pox happening after vaccination in some institutions and districts in far greater numbers than would in all probability have been the case, had the individuals, instead of being vaccinated, been subject to inoculation. The children of Christ's Hospital, for instance, are under medical mapagement of the most respectable kind; and the diseases happening in this institution are carefully recorded in quarterly reports. Now in these reports, • Variola post vaccinationem' often occurs-a sequence which was not noticed, at least not recorded, when the boys were generally, as in former years, inoculated. We have further, another report from authority of an indisputable kind, stating, that in one small town and its immediate neighbourhood, fifty-four cases had been seen of small-pox subsequently to the vaccine disease. These, then, we repeat, and other testimonies more or less strongly to the same effect, are certainly calculated to make us pause before we set our hands to the proposition, that there is an absolute identity of preventive effect in genuine small-pox and genuine cow-pox.
Vaccination, however, has, we conceive, enough of positive evidence in its favour to meet all that has hitherto been advanced against it
, either in the way of argument or fact. In the first place, it is to be observed, that with very little exception indeed, the cases of the variolous occurring after the vaccine affection, are of so mild and modified a nature as to be hardly worthy notice; and that
even when such cases assume in the first stages somewhat of a malignant type, the unfavourable symptoms soon die away, and the period of danger in other variolous disorders becomes in these the period of convalescence. This, indeed, with the most trifling exception, is so much the case, that for our own parts we should witness with next to nothing of apprehension, small-pox breaking out among our own children, or the children of our relatives; and the strongest evidence that has hitherto been adduced against vaccination has never produced any solicitude in our minds that the children in whose welfare we are more immediately interested should be kept from small-pox exposure. Secondly, we may remark, that this kind of small-pox, thus modified and disarmed of all its malignity, has so many features of resemblance to those eruptions which are named chicken-pox, that it is fair to presume many supposed instances of the former have been in reality cases of the latter. This may easily be conceived, when we advert to the apprehensions of some, and we are concerned to state the apparent desire of others of meeting with facts adverse to the vaccine cause. Indeed, we scarcely hear now, as we were wont to do, of chicken-pox, but every eruption is put down to the head of small-pox after cow-pox.
But, thirdly, what shall we say to foreign reports in favour of the new practice? Amsterdam, it is affirmed,
has not for a long time seen a single case of small-pox subsequent to vaccination; and in the year 1813, a report was published by the imperial institution of France, stating that 2,671,622 subjects had been properly vaccinated in France, of whom only seven had afterwards taken the smallpox! and it was added, that the well authenticated cases of persons taking the small-pox after variolous inoculation are proportionably far more numerous : and, indeed, reports of a similar nature reach this country from every part of the world in which the new practice has obtained and where has it not obtained ? It may be still urged that the immunity, after all, may be only for a time; but besides that this supposition violates the laws of all analogy, it is, in truth, contrary to the evidence of fact. Dr. Jenner, as we have already noticed, actually proved the impotency of the small-pox virus, as applied to individuals who had been subjected to the cow-pox fifty years before the experiment; and, let it be observed, as an important circumstance, that even natural cow-pox is imparted in the way of inoculation.
In conclusion, then, we would express it as our sincere and unbiassed conviction, that whether vaccination be or be not precisely the same as variolous inoculation, in regard to its preventive power over small-pox, it is demonstrably efficacious enough to justify its universal adoption; and that it deserves to be appreciated as one of the greatest blessings ever bestowed upon mankind by a