Imagens das páginas

of its advocates is compared with the feeble and imperfect testimonies of its few opposers; and when it is considered that many who were once adverse to vaccination have been convinced by further trials, and are now to be ranked among its warmest supporters, the truth seems to be established as firmly as the nature of such a question admits; so that the College of Physicians conceive that the public may reasonably look forward with some degree of hope to the time when all opposition shall cease, and the general concurrence of mankind shall at length be able to put an end to the ravages at least, if not to the existence, of the small-pox.'"

Discussion was now at an end for a time. Henceforth the public mind was apparently quite satisfied on the subject, and from this period vaccination became universal among the children of the educated classes in this country.

“The commencement of this century," writes Dr. Copland, "was remarkable for the progress of vaccination. In 1801 upwards of six thousand persons had been vaccinated, and the greater part had been tested with small-pox. In 1800, 1901, and 1802, vaccination was introduced into France, Germany, Italy, Spain, and the East Indies. In 1802, Parliament voted Dr. Jenner a reward of 10,0001. for the discovery; and, in 1807, the additional sum of 20,0001.; and in 1808 vaccination was taken under the protection of Government."*

The general assent of the medical profession appears to have been given at a much earlier period, at least fifty years ago, and was all but unanimous. There were, and there still exist, as we learn from Mr. Simon's papers, three sources of opposition. These are (1) hereditary opposition among the descendants of those whose fathers, friends, and teachers were contemporaries of Jenner, and among whom the old allegiance finds here and there a surviving follower of Birch, the surgeon of St. Thomas's Hospital; (2) the operation of personal eccentricities against the common convictions of mankind; (3) persons who for sinister purposes are always ready to oppose any project, independent of its merits.

Another source of opposition, however, appears to us to have been entirely lost sight of by Simon-namely, (4) that there are men impressed with the sincere conviction that neither vaccination nor inoculation affords that security and protection from small-pox which is generally believed to follow-a conviction impressed on their minds by a concurrence of what may be termed untoward instances within the limits of their own observation and experience.

It is now fifty-nine years since Jenner first promulgated his discovery to the world, and modestly said “he would continue to prosecute bis inquiry, encouraged by the hope of its becoming beneficial to mankind." He felt a holy reliance in the truth of his discovery, and as he himself said, the keenest of all arguments which will be used against those who opposed the practice of vaccination, will be those which are engraved with the point of the lancet! This prediction has been fulfilled, as the works we have been privileged to review, enumerated at the head of this article, abundantly testify.

With one exception, in the writings of Dr. Copland, their conclusions are unqualified in favour of vaccination. He stands aside, along with Dr. Hamernjk of Prague, and to the opinions expressed by both of them we shall by and bye refer.

* Dictionary of Medicine, art. Vaccination, p. 1236.

One would think it, at first sight, almost an insult to the human understanding to be obliged to collect statistics at this period to prove that vaccination confers a large exemption from attacks of small-pox, and almost absolute security against death from that disease. But so it is, and independent of the information which such statistical inquiry is calculated to convey to those who advise our lawgivers in high places, it is an eminently useful instrument of research in relation to everything which bears upon the nature of this disease.

The highest medical authorities, to which we can refer, recommend “ That all views and facts objected to vaccination be rigorously inquired into, and that there be published annually, in some journal of large circulation, a true account of such inquiries, and an elucidation of whatever has seemed doubtful or contradictory; together with instances in which vaccination, or more particularly re-vaccination, has given protection against the contagion of small-pox, when this disease has been in the neighbourhood.”

So writes Dr. Sigmund, Professor in the University of Vienna, and a no less distinguished authority and most amiable man, Dr. Alison of Edinburgh, the first Physician to Her Majesty for Scotland, and Emeritus Professor of Medicine, writes as follows:

“It is to be observed, however, that the poisons producing all epidemic diseases are subject to variations, sometimes rapid, sometimes very gradual, both as to intensity and to several of the effects they produce; which makes it right to have the evidence of the efficacy of any such protecting power as COW-pox has shown now for years, subjected to examination from time to time, with the view of ascertaining whether any such modification of its usual power has taken place."

While, therefore, the subject of vaccination has had a large share of our attention-as the pages of this Journal and that of our predecessor can testify through a series of years—still, for the sake of the principles advocated by Dr. Sigmund and Dr. Alison, we willingly accord to the subject any aid and countenance which a prominent notice of the works before us can confer.

In 1841 the Vaccination Act was passed by the British Parliament, which rightly made the practice of inoculation unlawful. In 1853 another Act was passed with the view of rendering the practice of vaccination compulsory. This later Act is known as Lord Lyttelton's Vaccination Act. During the interval between the first and second reading of the Bill, “the Small-pox and Vaccination Committee of the Epidemiological Society” completed a report on the prevalence and mortality of small-pox in different countries, and on the means taken to guard against its propagation, and to diminish its mortality through vaccination. This Report (understood to be especially the work of Dr. Seaton) was enclosed in a letter to Lord Palmerston, with the view of strengthening the hands of Government, and encouraging Her Majesty's Ministers to pass an efficient measure relative to vaccination.

The conclusions arrived at in this Report are deduced from the largest and most accurate mass of statistical evidence which had ever been brought to bear upon the question. We shortly noticed its appearance at the time in our Bibliographical Record,* Government having considered it so important as to cause its being printed as a Parliamentary paper, but we were unable to enter then upon a review of the important subject on which it treats. We now place it first on the list, not only because it is so chronologically, but because we believe it to be a most valuable record, and because the material it contains does not seem to have received that attention which the importance of the subject, the care and the labour brought to bear on its elucidation, deservedly ought to command. The Report, too, appears to have been prepared in so short a time that the information and statistical data it contains have not been made so much of as they deserved, by a more lengthened consideration of the subject; and the valuable little pamphlet of Dr. Seaton may be read as a supplement to the Parliamentary Report, for it demonstrates in a stronger and more forcible manner than had been done in the Report, the modifying and protecting powers of vaccination.

However satisfactory it may have been to have passed Lord Lyttelton's Act, it is now well known that the Act has proved but a very imperfect measure, and one which has fallen far short of accomplishing all that is yet required. The inefficiency and imperfect working of the Act is fully shown in the Reports of the RegistrarGeneral for 1854, by the medical profession generally, by the medical registrars in particular, and by the public, as expressed now and again in the public newspapers. Much might have been done to remedy the existing defects of the Act and facilitate vaccination to the people by the Government measure of last year, which the ill-directed influence of erroneous popular belief caused to be postponed. No one, perhaps, was more active in defeating its progress than Mr. Mitchell, whom the recent appeal to the country has deprived of his seat in Parliament, and who appears to have had a virulent hatred to the memory of Jenner, for he believed that vaccination had introduced " no end” of diseases into the human body! and that the existence of cow-pox had been a curse to mankind !! It is lamentable that the progress of medical science should be obstructed in the aid it might receive from Government by the influence of such representatives of the people. Such displays only cause us to lament that the medical profession has no representative in our legislative assemblies, while the law, the church, and the profession of arms are fully represented; and while many of these representatives are permitted and called upon to fill high offices of state, hardly even a seat in the House of Commons can be secured for a member of the medical profession; and when one does find a place in that honourable House, he takes his seat as the representative of a civic community, not of a learned, enlightened, and humanizing profession. Hence it is that questions which involve an accurate and extensive knowledge of the science of Medicine, do not receive that unbiassed,

* British and Foreign Medico-Chirurgical Review for 1868, p. 463.

careful consideration and elaborate discussion which they demand, and that all questions which affect the interests of public health are virtually determined by men who have no voice in Parliament, but whose professional opinions must be obtained and instilled into those who are to settle the most abstruse questions in State Medicine, and to legislate accordingly. We again enter our protest against this state of things. We desire the medical profession to be fairly represented in Parliament, and we wish to see some distinguished physician the President of the Board of Health, if that institution is to be continued; at all events let him have a seat in the Privy Council of Her Majesty's Government, and a voice in the legislative assemblies of our country.

To the existing state of things, however, we owe the appearance of the work which stands last in the list, and which, in June last, emanated from the Board of Health.

The medical officer of the General Board of Health (John Simon, Esq., F.R.S.) having been desired by the Right Honourable the President of that Board " to lay before him such medical facts and considerations as may assist him in estimating the hygienic value of vaccination, and the strength of any objections which may have been alleged against its general adoption,” we have accordingly before us a large mass of most important material bearing on the history and progress of vaccination, and its influence in arresting the ravages of smallpox during the past half century. Most valuable documents have thus been collected and printed as an Appendix to a letter written by the medical officer, and addressed to the President of the Board, in which the following questions are considered in an interesting narrative style-namely :

“I. What kind of an evil was small-pox before vaccination arose to resist itp

"II. What facts and arguments led to the first sanction of vaccination, and to what sort of inquiry were they subjected ?

“III. What further knowledge, at the end of half a century's experience, has been gathered on the protective powers of vaccination.

"IV. What evils have been shown to attend its practice, and to counterbalance its alleged advantages ?

" V. How far are there realized, in this country, those benefits which can reasonably be expected from the general use of vaccination?"

Under each of these heads, the honourable President of the Board of Health has presented for his consideration some of the most abstruse questions in pathology; but the state of our knowledge is made as plain to him as it possibly can be by the comprehensive descriptions and forcible illustrations of Simon. It is not to be understood that the topics discussed in this admirable work are at all novel, or that anything has been brought forward on the subject of vaccination which has not been already noticed and discussed in the pages of this Journal or in that of our predecessor, as fir as existing information would admit.*

Nevertheless, this work from the Board of Health is especially

. See British and Foreign Medical Review, rols. vi. to ix.

valuable now, because it brings together a body of evidence, down, as it were, to the present day,-evidence of a statistical kind,—the records which have been engraved by the lancet's point, and the dames of men and bodies of men as societies, who have done the most for vaccination, are brought prominently forward.

Passing over the history of small-pox before Jenner's great discovery, the great dangers of its attacks in the natural form, and the different circumstances under which it has prevailed as epidemic, let us review the statements of Mr. Simon, contained in the last three topics of his inquiry.

“ Tested by half a century's trial on millions of civilized Europe, what has vaccination achieved ? Comparing the small-pox mortality of the last forty or fifty years with that of as many years in the last century, do we find a sensible difference? Has progress been made towards that final result which Jenner anticipated—the annihilation of the most dreadful scourge of the human race.

The immense amount of important material, already condensed in tabular forms in the works before us, renders it difficult to give a readable extract of them in a review. Accordingly, we shall attempt to illustrate only the more important topics from the combined researches of all.

Let us consider first the nature and extent of the evidence now existing which demonstrates the protective influence of vaccination, and the causes which have combined to impair its protective power. Of these in their order, and: I. Of the Protection conferred by Vaccination-its Nature, and the

Evidence of its Existence. The main features of the Report of the Epidemiological Society illustrate how small.pox diminishes in its mortality in proportion as EFFICIENT measures are adopted to ensure perfect vaccination. To demonstrate this, the progress of vaccination in Great Britain and in Germany is first compared as to its influence on mortality generally; and secondly, it is shown by comparing the statistics of vaccination from various German states with the statistics from different districts in Great Britain and Ireland, that where vaccination is most perfectly carried out, small-pox is least mortal. The following is a general record of the statistics which the committee of this society have collected: “1. To prove the influence of vaccination in England :

Out of every 1000 deaths in the half-century from 1750

to 1800, there were of small-pox . . . . . . . 96 Out of every 1000 deaths in the half-century from 1800

to 1850, there were of small-pox . . . . . . . 35 «2. To prove the influence of vaccination on the Continent:

In various German states, sufficient evidence can be ob

tained to show that, before vaccination was used,
out of every 1000 deaths, there occurred from small-

pox. . . . . . . . . . . . . . .

After vaccination there occurred . . . . . . . . 7.26 “3. To prove that in countries where vaccination is most perfectly carried

out, small-pox is least mortal:

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