Imagens das páginas
PDF
ePub

from small-pox? We believe that these questions disclose to every thinking mind, that a wide field of research must still be carefully and industriously worked out, not to be completed for many years ; and the more thought and study we have given to the subject of vaccination, the more does it appear to us that now we are treading on very delicate ground ; that vaccination is an operation not to be trifled with, that the effects which it produces on the community must yet be watched for years, in order that its prophylactic powers may be efficiently developed ; that many points in its pathology are still veiled in mystery, but that science has declared it to be a most powerful protection from small-pox, if properly performed, and that the guilt of the British Government is immeasurable, if it fail to secure, by efficient legislative enactments, complete and efficient vaccination for all, or if it tolerates its imperfect performance.

(d.) Regarding conditions which influence the protective powers of vaccination, there is yet another circumstance to be noticed-namely, the influence of idiosyncrasy and hereditary predisposition either to withstand the poison of variola or vaccinia, or to be unnaturally susceptible to its influence. We have beard of cases in which vaccidation never would take at any period of life, and that the person, being exposed to small-pox on many occasions, had not been found to be susceptible, but seemed to have an immunity as perfect as any protected person could possess. Cases of a reverse description unhappily are not unheard of, as the following note at the foot of page 30 of Simon's 'Letter will testify :

“In a medical pamphlet of thirty-five years ago* I read: There are strong grounds for believing that this peculiarity of constitution, which disposes to attacks of modified or vaccine small-pox, is hereditary. A medical friend writes to me, that he and his two brothers were vaccinated in infancy to the satisfaction of their then doctor; that some years subsequently, when they were severally aged thirteen, eleven, and seven, the second of them contracted small-pox in a very severe form, and the other two caught the disease from him; that my correspondent himself, when twenty years of age, having occasion to attend the post-mortem examination of a patient who had died of small-pox, again contracted the disease, and in his turn communicated a second infection to both his brothers, who, like himself, had suffered it before. Dr. Arnott tells me, that he attended in Spain a case of post-vaccinal confluent small-pox, where the patient's father had had small-pox twice, and her uncle three times, another uncle having died with a first attack of the disease. I have notes of an instance-published, I believe, by Dr. Webster—where three brothers and sisters had had post-vaccinal small-pox; one of them once, another twice, and the other three times, including a last and fatal attack.”

Such cases as these now noticed, however, are surrounded with many fallacies; and before we are justified in ascribing them to hereditary predisposition or idiosyncrasy, all the other elements we bave already alluded to as modifying the protective power of vaccination must be strictly eliminated before such an explanation can be admitted. We are ourselves acquainted with an instance, where it was believed that vaccination, as performed by the doctor, “never took," and yet this individual was

• Address to Parents and Guardians on the Present State of Vaccination. By a Candid Observer, p. 47. London, 1822.

found never to be susceptible to the influence of the small-pox poison, although frequently exposed to it. On carefully sifting the history of this case, it was discovered that during early life the individual had been in the habit of handling and tending upon cows, and although he could not remember having sores on his hands from them, it is more than probable that he received his protection in this way.

III. Legislative Measures to secure Efficient Vaccination. This topic is discussed both by the Epidemiological Society and by Mr. Simon.

The following advertisement, taken from one of the public newspapers, will show how these things are managed in this country. We contract for vaccination just as Government, the East India Company, or any large manufacturer would contract for a supply of coals! That such a course should ever have been sanctioned or necessitated is an insult to our profession, and that it should be responded to is no less disgraceful.

"- Union.-Compulsory Vaccination.—The Guardians of the above Union will, at their meeting, to be holden on Friday, the 10th July instant, at the Union Workhouse, situate at , in the county of receive Tenders from Medical Gentlemen duly qualified and willing to Contract for effectually Vaccinating in the District of this Union, comprising the following parishes, viz.,

, and also in the Union Workhouse. The Vaccinators to comply in all respects with the provisions and requirements of the Compulsory Vaccination Act of the 16th and 17th Vict. cap. 100; and all contracts will be made subject to termination at any time subsequent to the date thereof, by virtue of Legislative enactment. Particulars of the district, population, area, and other information, may be obtained on application to the Clerk.-By order of the Guardians, - , Clerk.”

We are surprised that the guardians do not pledge themselves to accept the lowest offer.

Two very obvious imperfections exist in the last Act of Parliament relative to this subject, the object of which, as the title informs us, is “To extend and make compulsory the practice of Vaccination.” In the first place, the Act “has not provided competent machinery by which its enactments can be carried out." In the second place, it does not recognise " that there is such a thing as bad vaccination."

We admit that it may be difficult to organize machinery efficient to secure perfect vaccination ; and there is evidence given by Mr. Simon which shows that every year the existing machinery has become less and less efficient. Looking, therefore, at the subject from a practical point of view, it is obvious to us

1. That an efficient machinery should be organized.

2. That provision should be made for the education of the profession in all that relates to the practice and pathology of vaccination.

It is unsatisfactory, however, to find fault unless at the same time a Tomody be sugrested. The necessity for the education and practical testing of melical men in regard to vaccination is shown in sufficient for by Mr. Simon; but he leaves untouched any details of a plan to walige an efficient system of vaccination. In all plans to effect this

object, sufficient advantage is not taken of existing national and local institutions, by calling in their aid as part of the machinery to carry out the spirit and letter of any legal enactment.

We submit the following outline of details, with the view of directing the attention of the profession to some specific means out of which an efficient machinery may, we think, be constituted to accomplish so desirable an end :

1. As suggested by the Epidemiological Society, it will be necessary to disconnect the practice of vaccination from the administration of the Poor-law Board.

2. Let a General Vaccination Board be constituted, under the auspices of the General Board of Health.

3. Let that Board be responsible for the organization of an efficient machinery which will secure universal and perfect vaccination.

4. Let the Board be responsible to Parliament, through the President of the Board of Health, who ought to be a medical man and a member of her Majesty's Government.

5. Let the Officers of Health recently appointed undertake the inspection of the community within their districts, as to whether or not they are properly vaccinated. It is a legitimate subject for their investigation. Indeed, we conceive such to be part of their duty by formule 18 and 19 Vict. cap. 120, of Sir Benjamin Hall's Bill.

6. Let one or more General Inspectors of Vaccination be appointed for each of the three parts of the British empire-England and Wales, Scotland, and Ireland ; and let the General Inspectors be members of the General Board.

7. Let the existing vaccinators continue to do their duty ; but let advantage also be taken of public institutions and local circumstances, as indicated above, to divide more and more the labour of vaccination, so that the operation may be more perfectly performed, and watched through its stages, in every case, as it ought to be.

8. Let legally qualified medical inen be the only persons permitted to vaccinate.

9. Let additional public vaccinators be appointed where required. Let every union and workhouse employ a vaccinator. Let every hospital in the kingdom employ a vaccinator-a suggestion made in the last report of the General Vaccine Board, and which we particularly recommended in our last number.

10. In all towns where schools of medicine exist, let the practice and pathology of vaccination form part of the medical education, and let every student of medicine be required to produce evidence of having attended and studied as prescribed, before receiving a diploma or licence to practise.

il. Let uniform registers be kept by all who vaccinate, subject to inspection by members of the Board.

12. Let certificates of vaccination be granted to the vaccinated by the Inspectors or Officers of Health for the respective districts, and not by the vaccinators.

13. Let the vaccinators, local inspectors, and general inspectors be remunerated by fixed salaries.

The labourer is worthy of bis hire: let him not be engaged by contract and paid with a grudge.

We have thus taken a comprehensive view of the important works before us relative to vaccination, the nature of the protection it affords, and the evidence of the existence of that protection. We have noticed how that influence has sometimes been impaired, and how more stringent legislative measures are imperatively demanded, not only to secure efficient vaccination for all, but to afford us the means of learning more accurately its pathology.

In now taking leave of our subject, let us formally express our profound respect for the memory of JENNER. We cannot help thinking that in this country we have paid but tardy homage to that illustrious name. Doubtless he has himself imprinted imperishable “foot-prints on the sands of time," which wave after wave of scientific research appears but to make more distinct; yet surely some lasting monument in this country ought to testify a nation's gratitude. A statue of the man, in honour of his great discovery, greets the traveller from the shore of a sister kingdom; and why should we be so regardless of one of our most illustrious dead? While monuments without number have been raised to perpetuate the deeds of warriors, whose fame has been achieved by the necessary destruction of countless human beings, surely we ought to cherish the memory and perpetuate the fame of one, by appropriate monumental honours, who, while he has been the means of subduing a disease, has been at once the means of improving the health of all civilized communities, and extending the duration of human existence.

REVIEW IV. Ueber die Bewegung der Iris : für Physiologen und Aerzte. Von

JULIUS BUDGE, Professor in Bonn.-Braunschweig, 1855. On the Motion of the Iris : for the use of Physiologists and Medical

Practitioners. By JULIUS BUDGE, Professor in the University of

Bonn, Brunswick, 1855. Svo, pp. 206. It is not alone in reference to the eye that the iris and its motions are of so much importance. The state of the pupil, it is well known, often afforels valuable indications of much that is going on beyond the sphere of the organ of vision. Any work, therefore, calculated to extend and give precision to our knowledge of the subject must be acceptable to the physiologist and medical practitioner. Considering the work before us as such an one, we have taken the pains to make an analysis of it. Comments and remarks which suggested themselves have been added, besides notices of observations on the subject by others, more recently published.

Musular Structure of the Iris-By means of the microscope, a muscular structure can be demonstrated in the iris. In man and in the mammifera the fibres are of the unstriated kind, like those of the walls of the stomach, intestines fe. In birds they are transversely sti interl, like those of the aummon muscles of the skeleton.

In man and the mammifera the muscular fibres of the iris are

divisible into two distinct sets; the one situated in the annulus major, and disposed in a somewhat radiating direction; the other situated in the annulus minor, and disposed round the pupil. It is by the action of these antagonistic sets of muscular fibres that the well-known variation in the size of the pupil is produced; the radiating fibres acting as a dilator, the circular fibres as a sphincter pupillo. The state of relaxation of the iris is that in which the pupil is neither much contracted nor much dilated; a medium state into which the pupil falls some time after death, and to which, in consequence of an elasticity, the tissue of the iris is at the same time endowed with, it has a constant tendency to return after the dilating or contracting muscular force has ceased to operate.

In birds there is no dilator pupillae. In these animals, dilatation of the pupil is the result of elasticity coming into play on the cessation of the action of the sphincter pupillæ. The state of relaxation of the iris in birds—the state in which it is found after death, therefore, is that in which the pupil is fully dilated.

In former times the muscularity of the iris was pretty generally admitted by anatomists, not so much, however, as Porterfield remarks, from their being able to demonstrate the muscular fibres, as from reason and analogy.

In the iris of man and the mammifera, indeed, there is not to be seen a tissue presenting any such appearances to the naked eye as those which used to be relied on by anatomists as characteristic of muscle. It was for this reason that Haller refused to recognise the muscularity of the iris, observing that we ought not to assume the existence of a structure which we cannot perceive by the senses. This philosophical reserve, however, Haller broke through when he attempted to explain the motions of the pupil by an afflux of blood to the iris, as in the case of erectile structures. This conceit found great favour with physiologists down to a very recent date, notwithstanding it involved much more improbability than the admission of simple muscularity.

Though rich in vessels, the iris presents nothing like an erectile structure; and, supposing contraction of the pupil to be owing to vascular turgescence of the iris, dilatation would be the state of the pupil during collapse. But we kuow that in man and mammifera complete relaxation of the iris is attended by a medium width of the pupil not by full dilatation, as in birds. In birds, the muscularity contracting the pupil, and elasticity dilating it, are too evident to be mistaken.

Nerves of the Iris. In mammifera, the frog tribe, and fishes, the ciliary nerves come from the ophthalmic division of the fifth, the oculomotor, and the sympathetic. In birds, the sympathetic contributes no fibrils to the ciliary nerves. ..Omitting what Budge says of the ciliary nerves as far as their entrance into the iris, in man, the dog, the cat, the rabbit, in birds, the frog, the barbel, we come to his account of their distribution in the iris. The substance of this is, that Budge never saw nerve fibrils in the iris with real free ends; they always appeared to form loops. He has also never found ganglions in the iris, either of man or the rabbit, which he has particularly examined, though Mayer had de

« AnteriorContinuar »