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1. During eight years which have elapsed since Dr. Jenner made his discovery public, the progress of vaccination has been rapid, not only in all parts of the United Kingdom, but in every quarter of the civilized world. In the British islands some hundred thousands have been vaccinated, in our possessions in the East Indies upwards of 800,000, and among the nations of Europe the practice has become general. Professional men have submitted it to the fairest trials, and the public have, for the most part, received it without prejudice. A few indeed have stood forth the adversaries of vaccination, on the same grounds as their predecessors who opposed the inoculation for the small-pox, falsely led by hypothetical reasoning in the investigation of a subject which must be supported, or rejected, upon facts and observation only. With these few exceptions, the testimony in favour of vaccination has been most strong and satisfactory, and the practice of it, though it has received a check in some quarters, appears still to be upon the increase in most parts of the United Kingdom.
II. The college of physicians, in giving their observations and opipions on the practice of vaccination, think it right to premise, that they advance nothing but what is supported by the multiplied and unequivocal evidence which has been brought before them, and they have not considered any acts as proved but what have been stated from actual observation.
Vaccination appears to be in general per.ectly safe; the instances
to the contrary being extremely rare. The disease excited by it is slight, and seldom prevents those under it from following their ordinary occupations. It has been communi cated with safety to pregnant wo men, to children during dentition, and in their earliest infancy; in aï which respects it possesses matenal advantages over inoculation for the small-pox; which, though produc tive of a disease generally mild, yet sometimes occasions alarming symptoms, and is in a few cases fatal.
The security derived from vaccination against the small-pox, if not absolutely perfect, is as nearly so as can perhaps be expected from any human discovery; for amongst several hundred thousand cases, with the results of which the college have been made acquainted, the number of alleged failures has been surprizingly small; so much so, as to form certainly no reasonable objection to the general adoption of vaccination; for it appears, that there are not nearly so many failures, in a given number of vacci nated persons, as there are deaths in an equal number of persons inoculated for the small-pox. Nothing can more clearly demonstrate the superiority of vaccination over the inoculation of the small-pox, than this consideration; and it is a most important fact, which has been confirmed in the course of this inquiry, that in almost every case, where the small-pox has succeeded vaccination, whether by inoculation or by casual infection, the disease has varied much from its ordinary course; it has neither been the same in the violence, nor in the duration of its symptoms; but has,
with a very few exceptions, been remarkably mild, as if the smallpox had been deprived, by the previous vaccine disease, of all its usual malignity.
The testimonies before the college of physicians are very decided in declaring, that vaccination does less mischief to the constitution, and less frequently gives rise to other diseases, than the small-pox, either natural or inoculated.
The college feel themselves called upon to state this strongly, because it has been objected to vaccination, that it produces new, unheard-of, and monstrous diseases. Of such assertions no proofs have been produced; and, after diligent inquiry, the college believe them to have been either the inventions of designing, or the mistakes of ignorant men. In these respects, then, in its mildness, its safety, and its consequences, the individual may look for the peculiar advantages of vaccination. The benefits which flow from it to society are infinitely more considerable; it spreads no infection, and can be communicated only by inoculation. It is from a consideration of the pernicious effects of the small-pox, that the real value of vaccination is to be estimated. The natural small pox has been supposed to destroy a sixth part of all whom it attacks; and that even by inoculation, where that has been general in parishes and towns, about one in three hundred has usually died. It is not sufficiently known, or not adverted to, that nearly onetenth, some years more than onetenth, of the whole mortality in London is occasioned by the small pox; and however beneficial the inoculation of the small-pox may have been to individuals, it appears
to have kept up a constant source of contagion, which has been the means of increasing the number of deaths by what is called the natural disease. It cannot be doubted that this mischief has been extended by the inconsiderate manner in which great numbers of persons, even since the introduction of vaccination, are still every year inoculated with the small-pox, and afterwards required to attend two or three times a week at the places of inoculation, through every stage of their illness.
From this, then, the public are to expect the great and uncontroverted superiority of vaccination, that it communicates no casual infection, and, while it is a protection to the individual, it is not prejudicial to the public.
III. The college of physicians, in reporting their observations and opiions on the evidence adduced in support of vaccinatios, feel themselves authorized to state that a body of evidence so large, so temperate, and so consistent, was perhaps never before collected upon any medical question. A discovery so novel, and to which there was nothing analogous known in nature, though resting on the experimental observations of the inventor, was at first received with diffidence: it was not, however, difficult for others to repeat his experiments, by which the truth of his observations was confirmed, and the doubts of the cautions were gradually dispelled by extensive experience. At the commencement of the practice, almost all that were vaccinated were afterwards submitted to the inoculation of the small-pox; many underwent this operation a second, and even a third time, and the uniform suc304
cess of these trials quickly bred confidence in the new discovery. But the evidence of the security derived from vaccination against the all-pox does not rest alone upon those who afterwards underwent various inoculation, although amounting to many thousands; for it appears, from numerous observations communicated to the college, that those who have been vaccinated are equally secure againt the contagion of epidemic small-pox. Towns indeed, and districts of the country, in which vaccination had been general, have afterwards had the smallpox prevaleut on all sides of them without suffering from the contagiou. There are also in the evidence a few examples of epidemic small-pox having been subdued by a general vaccination. It will not, therefore, appear extraordinary that auy who have communicated their observations should state, that, though at first they thought unfavourably of the practice, experience had now removed all their doubts.
It has been already mentioned, that the evidence is not universally favourable, although it is in truth Dearly so, for there are a few who entertain sentiments differing widely from those of the great majority of their brethren. The college, therefore, deemed it their duty, in a particular manner, to enquire upon what grounds and evidence the op-, posers of vaccination rested their opinions. From personal examination, as well as from their writings, they endeavoured to learn the full extent and weight of their objections. They found them without experience in vaccination, supporting their opinions by hearsay information, and hypothetical reasoning;
and, upon investigating the facts which they advanced, they found them to be either misapprehended or misrepresented; or that they fell under the description of cases of imperfect small-pox, before noticed, and which the college have endeavoured fairly to appreciate.
The practice of vaccination is but of eight years standing, and its promoters, as well as opponents, must keep in mind that a period so short is too limited to ascertain every point, or to bring the art to that perfection of which it may be capa ble. The truth of this will readily be admitted by those acquainted with the history of inoculation for the small-pox. Vaccination is now, however, well understood, and its character accurately described. Some deviations from the usual course have occasionally occurred, which the author of the practice has called spurious cow-pox; by which the public have been misled, as if there were a true and a false cowpox; but it appears, that nothing more was meant, than to express irregularity or difference from that common form and progress of the vaccine pustule from which its efficacy is inferred. Those who perform vaccination ought therefore to be well instructed, and should have watched with the greatest care the regular progress of the pustule, and learnt the most proper time for taking the matter. There is little doubt that some of the failures are to be imputed to the inexperience of the early vaccinators, and it is not unreasonable to expect that farther observation will yet suggest many improvements that will reduce the number of anomalous cases, and furnish the means of determining, with greater precision, when the
accine disease has been effectually of frightful and monstrous apeceived.
Though the college of physicians have confined themselves, in estimating the evidence, to such facts as have occurred in their own country, because the accuracy of them could best be ascertained, they cannot be insensible to the confirmation these receive from the reports of the successful introduction of vaccination, not only into every part of Europe, but throughout the vast continents of Asia and America.
IV. Several causes have had a partial operation in retarding the general adoption of vaccination; some writers have greatly undervalued the security it affords, while others have considered it to be of a temporary nature only; but if any reliance is to be placed on the statements which have been laid before the college, its power of protecting the human body from the small-pox, though not perfect indeed, is abundantly sufficient to recommend it to the prudent and dispassionate, especially as the smallpox, in the few instances where it has subsequently occurred, has been generally mild and transient. The opinion that vaccination affords but a temporary security, is supported by no analogy in nature, nor by the facts which have hitherto occurred. Although the experience of vaccine inoculation be only of a few years, yet the same disease, contracted by the milkers of cows, in some districts, has been long enough known, to ascertain that in them at least the unsusceptibility of the small-pos-contagion does not wear out by time. Another cause is, the charge against vaccination of producing various new diseases
Representations of some of these have been exhibited in prints in a way to alarm the feelings of parents, and to infuse dread and appre hensions into the minds of the uninformed. Publications with such representations have been widely circulated; and though they origi nate either in gross ignorance, or wilful misrepresentation, yet have they lessened the confidence of many, particularly of the lower classes, in vaccination: no permanent effects, however, in retarding the progress of vaccination, need be apprehended from such causes; for as soon as the public shall view them coolly, and without surprize, they will excite contempt, and not fear.
Though the college of physicians are of opinion, that the progress of vaccination has been retarded in a few places by the above causes; yet they conceive that its general adoption has been prevented by causes far more powerful, and of a nature wholly different. The lower orders of society can hardly be induced to adopt precautions against evils which may be at a distance; nor can it be expected from them, if these precautions are attended with expence. Unless, therefore, from the immediate dread of epidemic small-pox, neither vaccination nor inoculation appear at any time to have been general; and when the cause of terror has passed by, the public have relapsed again into a state of indifference and apathy, and the salutary practice has come to a stand. It is not easy to suggest a remedy for an evil so deeply imprinted in human nature. To inform and instruct the public mind
may do much; and it will probably be found, that the progress of vacci nation in different parts of the United Kingdom will be in proportion to that instruction. Were encouragement given to vaccination, by offering it to the poorer classes without expence, there is little doubt but it would in time supersede the inoculation for the small-pox; and thereby various sources of variolous infection would be cut off; but till vaccination becomes general, it will be impossible to prevent the constant recurrence of the natural small-pox by means of those who are inoculated; except it should appear proper to the legislature to adopt, in its wisdom, some measure by which those who still, from terror or prejudice, prefer the small-pox to the vaccine disease, may, in thus consulting the gratification of their own feelings, be prevented from doing mischief to their neighbours.
From the whole of the above considerations, the college of physicians feel it their duty strongly to recommend the practice of vaccination, They have been led to this conclusion by no preconceived opinion, but by the most unbiassed judgment formed from an irresistible weight of evidence which has been laid before them. For when the number, the respectability, the disinterestedness, and the extensive experience 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 ad
mits: so that the college of physcians 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 stal at length be able to put an end to the ravages at least, if not to the existence, of the small-pox.
LUCAS PEPYS, President. 10th April, 1807.
It is lamentable to observe, that the small-pox is still suffered to be propagated by inoculation, which tends to disseminate the disease by casual infection; so that at present, in London alone, twenty-five persors a week die of that disease; and the usual amount of deaths, according to the London bills of mortality, is 2,000 at least.
There are no means of ascertaining exactly the number of deplorable sufferers, who, though not quite destroyed by the small-pox, are nevertheless grievously afflicted for life from that loathsome disease; but the number rendered blind, lame, scrofulous, deformed, and disfigured, is immense, and is estimated much below the truth at three times the amount of the deaths.
The account then may be fairly stated thus:
Deaths in London alone in one year from the small