The Results of Vaccination.

If the experience of nearly eighty years has not justified Dr. Jenner's expectation that smallpox would be extinguished by his discovery, the results have been sufficiently striking, as can be conclusively proved by statistics. The apparent failures are due, in our opinion, to no inherent defect in the principle of vaccination, but to the simple operation being too often carelessly and inefficiently performed, and to the constant evasions of the Vaccination Acts which take place in spite of the most stringent regulations. A. careful study of the whole subject has convinced us, and page 7 will we expect convince our readers as well, that under careful, complete, and efficient vaccination, the disease of smallpox would become a pathological curiosity amongst us. At the same time it is to be borne in mind that there is in every community a certain proportion of individuals who are liable to take small-pox twice or oftener, just as we find others taking scarlatina or measles more than once. As an example of what is here stated, it is well known that Louis the Fifteenth died of a second attack of small-pox. Yet cases like his are so rare that it may be said of them that the exception proves the rule. But vaccination does not act solely in the way of absolutely protecting from small-pox. It also has a controlling power over that disease, which is taken in a milder form after vaccination, and runs a more favourable course, the primary fever being less severe, the eruption more scattered, the pustules neither so deep nor so much inflamed, the scab maturing sooner and very rarely pitting, and there being no secondary fever.

Look we now to the statistics of the disease. In 1780 the deaths throughout England and Wales amounted to about 1 in 40 of the population; in 1811 they had declined to 1 in 52; and in 1821 they had sunk to only 1 in 58; and are at present 1 in 62. It is in accordance with observed facts to credit the operation of vaccination with this great reduction of nearly 50 per cent, in the death rate. But this is brought out most conclusively in the following table:—

Table showing the average of deaths from small-pox out of every 1000 deaths from all causes during the half century preceding vaccination.

For the 10 years ending 1760	100
For the 10 years ending 1770	108
For the 10 years ending 1780	98
For the 10 years ending 1790	87
For the 10 years ending 1800	88

Table showing the same during the half century succeeding the introduction of vaccination.

For the 10 years ending 1810	64
For the 10 years ending 1820	42
For the 10 years ending 1830	32
For the 10 years ending 1840	23
For the 10 years ending 1850	16

In regard to other countries it is shown in Mr. Simon's blue-book that the fatality of small-pox in Copenhagen is but an eleventh part of what it was before the introduction of vaccination; in Sweden little over a thirteenth; in Berlin and in large parts of Austria but a twentieth; in Westphalia but a twenty-fifth.

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The decline in the death rate from small-pox is even more conspicuously seen by the following table:—

Periods compared.	Annual death-rate of small-pox per million of population.
1. Average of thirty years previous to the introduction of vaccination	3000
2. Average of three years (1838-40) when vaccination had become diffused, but before public provision was made for its gratuitous performance	770
3. Average of nine years, when public vaccination was gratuitously provided, but was not compulsory (1841-53)	304
4. Average of twelve years (1854-65), during which vaccination was, to a certain extent, obligatory	202

Facts equally conclusive are derivable from the health statistics of Her Majesty's troops. From 1817 to 1836 the following facts are recorded:—In Dragoon regiments and Guards, with an aggregate strength of 44,611 men, and a total mortality of 627, there were only three deaths from small-pox. Among the troops at Gibraltar one death occurred, the aggregate strength being 60,269, and the whole mortality 1291.

In the West Indies, although several epidemics of small-pox had ravaged the islands within these years, not one person died of the disease among the British or white troops, out of an aggregate strength of 86,661 and a total mortality of 6,803; while among the black troops (who had all been thoroughly vaccinated on enrolment) numbering 40,934, with a mortality of 1,645, there was not even one case of small-pox.

At Bermuda, Nova Scotia, New Brunswick, Cape of Good Hope, and the Mauritius, not a single death from small-pox occurred during those 20 years, and even the white troops of Western Africa wholly escaped this disease which was carrying off hundreds of the black unprotected population. But the strongest evidence of the protective power of vaccination is derivable from the experience of our troops in Malta from 1818 to 1836, when only two deaths occurred from small-pox amongst 40,826 British troops; whereas amongst the civil population of the island, all unprotected, there was a mortality of 1,169 persons in the years 1830 and 1831 alone, when small-pox raged as an epidemic.

It cannot be a matter of surprise, with such statistics before us, that vaccination gradually entered into the life of the nation, became highly popular, and formed a part of the daily routine of family life. If there were any objectors to the practice, their complaints had not page 9 as yet penetrated the public ear, but were either confined to their own bosoms or limited to the circle of their private acquaintances. We must now turn our attention, however, to the rise and progress of the recent crusade against vaccination, answer the objections urged by anti-vaccinationists, and point out what measures should, in our opinion, be adopted to improve the practice of vaccination as now adopted, in order to thoroughly stamp out the much-dreaded small-pox.

The attention of the legislature and of the public was first forcibly attracted to the subject of vaccination by a severe outbreak of smallpox, assuming an epidemic type, which took place in London in 1871. The government showed itself alive to the urgency of the position by appointing a special commission to inquire into the causes of these outbreaks, and to discover any defects in the existing Acts. Several eminent members of the medical profession took up the subject of their own accord, and pursued it with such painstaking research and fulness of inquiry as to materially supplement the labours of the commissioners. Nor were the opponents of vaccination less active. Hitherto there were to be found here and there a few individuals who objected on various grounds to the operation, and refused to have their children vaccinated. But these crotchety persons carried no weight, and their example was lost upon the public. Now, however, taking advantage of the scare of the public, they organised themselves into associations, having for their object the repeal of the Compulsory Vaccination Act. They produced statistics—manufactured, of course, by themselves to suit their preconceived opinions—to prove their objections. They circulated pamphlets in which they denied the beneficial effects of vaccination, and urged that it introduced into the system unheard-of diseases. Their mischievous efforts bore fruit among the ignorant section of English society, and there are now hundreds of parents who prefer fine and imprisonment to vaccinating their children; indeed, for a time their labours were crowned with so much success that it seemed as if England, the birth-place of vaccination, were to be robbed of the benefits of .Tenner's discovery. By and by the report of the special commission was issued, and several able pamphlets appeared from the pens of well-known medical men. The friends of vaccination were pleased to find therein overwhelming proofs of the success and efficiency of the operation, and a triumphant refutation of the slanderous and misleading assertions of its opponents. But so difficult is it to eradicate error and scandal, however baseless, that such idle tales will no doubt be repeated and accepted as truthful for generations. The commission clearly traced the extent of the recent epidemic to the total neglect of vaccination in numerous cases, and to the careless and inefficient manner in which the operation was carried out in others. The Acts were accordingly amended so as to remedy the defects which had come to light; and there can be no doubt that

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vaccination is at present carried out far more faithfully and efficiently in Great Britain than at any former period of its history.