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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 nature. 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-pox 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 practice 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 de
VOL. 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 operated upon.
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 had as many children been inoculated, in place of being vaccinated, the instances of failure would be equally numerous. 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 principal 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 Inoculation.
Admitted for natural Small-pox.
The reader who shall cast his eye over the above table will ceive 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 management 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 BB 2
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 1815, 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
beneficent Providence. It is a mild substitute for a most malignant distemper; it is certainly not more influential in exciting latent complaints of the constitution, most probably much less so, than the old inoculation; and, to crown all, it does not sow the seeds among the community of a loathsome and devastating distemper!
On the merits of the treatises, the title-pages of which stand at the head of this article, we need say but little. The first of the volumes we have indeed tacitly expressed our approbation of, by the large use we have made of its contents. It is a most interesting,―we had almost said (notwithstanding that it is a treatise on small-pox) a fascinating work. The author has proved himself rich in resources and masterly in the management of them. Indeed, we have no hesitation in placing this performance of Mr. Moore among the few lasting monuments of medical literature. Sorry, however, are we to add, that the spirit of the partizan has, in the second volume, too much taken place of the mind of the liberal and learned historian; its composition, too, as a literary production, is, in all respects, inferior to the other. The author has been guilty in it of many offences, not merely against precision and taste, but against the most common principles of grammatical construction; and these become more conspicuous when contrasted with the chaste and classical style which pervades his History of Small-pox.
ART. VI.-Essays on the Proximate Mechanical Causes of the General Phenomena of the Universe. By Sir Richard Phillips. London. 12mo.
IT is not without some reason that the life of a man of science is commonly thought dull and uninviting. He spends his time in researches of remote utility and little general interest, and it is in most cases only by toilsome processes, and after repeated disappointments, that he arrives at his results. There are some, however, who attain the same ends by easier means, whose ardent progress in discovery no cold medium knows,' who scorn the slow path of gradual advancement, and leap at once beyond the farthest bounds of knowledge.
Of this small, but envied class, Sir Richard Phillips appears to be a distinguished member. His mind, unfettered by prejudice, unincumbered by knowledge, can at one glance, and apparently without any remarkable expenditure of thought, see through the fallacies of those systems of philosophy which have till now deluded the world, and dive into the secret foundations of nature. He has kindly and boldly determined to communicate his discoveries to the world. With a chivalrous spirit, worthy of a knight of better times, he despises the dangers which await such an undertaking. Of these