IMAGE EVALUATrON TEST TARGET {MT-3) 1.0 I.I *- ilM m IIIIIM iU m M 1.8 1.25 1.4 J4 .4 6" - ► m n d N n 32X I" 1 2 3 1 2 3 4 5 6 m^ w^r 1' W^TyyTz^^^ rr— 3 LECTURE/ UJRARV t 's> -ON — VAOCINATI 9 ■»•/;■.•■■ f • •..» -BY- VS^. H. HINGSTON, M.A., M.D., MAYOR OF MONTREAL. ;lHontrcal : REPRINTED FROM "PUBLIC HEALTH MAGAZINE.' mimm MM ^^ '■ -'^•■■' "4, ■ r.- ■ ■'■- s ■T .e^'.' ■ "'■ ';''^\ ':,.^' \,-ii*^''' ., - ' .,i *-* *<■• .'«•>-■ ■V- -m . I, ^--^^ :" i ^■^' -/■^ >• ^ f * / ^ - >^l 4 --^^ ' J «r' -« ■* ''(",' ' T i ^ ' ,^ H-c,, , ' A, * < U -i <^ ] • ' /«. 1 ,,,,'• .■- ' -" ^ '^ ^ ' ^;-' ,1.'*' " <" f^ _ - t ^os^V Vy "* .->*.' f^ / "N ' -a *' •• "»'«» aw. . i "'- v-^^ t3«'^ *--^C« >.• ^r- 5s^* -- f^ .. .^^ - -A - ^v^-'^ *>■? J ' iCk. V. f- > ii<^' - ,^-5*l\,J>r ^\*> t -C.Ti. 7!' \4i\ t 1 LECTURE ON V^5s. O O I IsT .i^ T I O HNT , BY W. H. HINGSTON, M.A.,M.D., &c., MAYOE 01 MONTKEAL, Delivered, 20th October, to the Public Vaccinators and other invited Physicians and Citizens. ; -■'f ^■f Cxentlemen : It lias been suggested to me by some of your body that, in addition to the directions issued by the Board of Health, for tlie guidance of vaccinators, something might be said to meet the objections urged by some active but mistaken writers against the practice of vaccination. Had similar articles been written against the practice of setting fractures ; of reducing dislocations ; or of removing dead parts from living bodies, 1 should have thought it useless to reply : for if surgeons contend that a dislocated bone should be reduced, the profession — I speak of its more experienced members — is almost equally unanimous in favor of the practice which some so persistently, and so unfortunately, denounce. It is something to array oneself against the general belief. To follow quietly in the footsteps of those who, in all things else, medical, are our guides, brings with it, to the mind, less f/af^ than to take up arms in what may be considered a ; afe warfare — safe, perhaps, to the combatant, but fraught with terrible mischief to those most interested. To prove to the unprejudiced, that vaccination exerts a protective influence over the econoni}', would be an easy task, for the writings of thousands, from the time of Jenner to our own day, are before us for the purpose ; but to attempt to convince those who persistently close their eyes to the over- -1 I I'i whelming evidence of almost every country and government in the world, including our own, would be as fruitless as was the effort to convinc-e the disbeliever in matter of the reality of the missile which almost knocked off his too unyielding head. In deference, however, to wishes expressed and suggestions offered at a meeting on Wednesday last, I venture some observations on this disease, now unfortunately too prevalent, and on the means which science has furnished for its prevention. Small-pox has its "periods of dormancy, and its periods of activity," at one moment overspreading a district, and at another disappearing. It is fatal in direct ratio to its epidemic character. Cases occur- ing sporadically (here and there in spots), are not so fatal. It is the most contagious of all diseases ; and this is a point on which I wish to insist, for some industriously endeavor to circulate the belief that small-pox drops upon individuals as rain drops from heaven — touching this one and sparing that ! It is communicable in every way ; " by inoculation, by breathing a contaminated atmosphere, by the contact or vicinity of fomites." It is infectious in the early febrile stage; infectious before and during the eruption ; and infectious " so long as any of the dry scabs result- ing from the original eruption remain adherent to the body.'' It may be caught, therefore, from the living body ; it may be caught from the dead body; or it may be caught from clothing and furniture near the living or the dead body. So much has this foul disease been dreaded, that different nations in time past endeavored to mitigate the malady by communicating it artificially. The Brahmins in India engrafted the virus ; so also did the Turks ; and the Chinese were in the habit of putting some of the crusts into the nostrils. The practice of inoculating with small-pox virus became more or less general in Europe, and " its efficacy in mitigating the severity and the danger of the disease " was considered to be very great. While it is estimated that one third of those who take the natural small-pox die, not 8 more than three or four in a thousand are destroyed by the ingrafted disease. Curschmann states it to have been about two per cent. But the time for small-pox inoculation is past, as the law has forbidden it. Eighty years ago a chance observation was matured into a rational and scientific form by a mind deeply imbued with the best principles of sound philosophy. A disease, mild in form and Siife in character, was substituted for the inoculation of the Turks and Chinese. In 1798 Jenner published his first important paper. In 1799 the first public institution for vaccination was established in London ; and in the following year it was introduced into France and Germany ; and the practice of vaccination has now become general over the whole educated world. Here and there, as might be expected, it has met with opposition ; but every objection that has been urged by the anti- vaccinator has been answered again and again by the leading minds of the profession. So much is this the case that 1 feel I owe something like an apology to my medical brethren for writing affirmatively of a practice most of them endorse. I that spoke a moment ago of Jenner as a discoverer ; but Jenner did not discover vaccine any more than Watt discovered steam. He noticed the prevalent belief among the peasantry in the immu- nity from small pox enjoyed by farm servants and milk maids ; and little by little he drew the conclusion which has been so pregnant with benefit to mankind. The belief in the existence of a vaccine virus was not confined to Englani . Cow-pox and its relations to small-pox had been woticed long before on the continent of Europe ; and in France and Germany numerous experiments had been made prior to the time of Jenner to show that persons affected by the natural vaccine virus were not susceptible to the small-pox influence. Jenner's merit con- sisted chiefly m producing the virus at will, and in diffusing it at pleasure for our advantage. And iiow slowly and how cautiously he advanced his every sfatement may be gathered from the fact that twenty-two years elapsed l)etween his first exr)eriment and the promulgation of his theory. He was assailed then, as his memory is to-dav, but with more excuse then than now; for no one having the leisure and the disposition to read, and having access to the records of medical observers, has now the shadow of an excuse for rejecting the theory then advanced, the critical aculeness of which, says Curschmann, may serve as a model. But we do things differently now-a-days, and a harangue in a market place or public square, by gentlemen who may, 'tis true, be authorities in law. but cannot be accepted as such in medicine, is deemed sufficient to initiate the uneducated masses into a knowledge of one of the most difficult and abstruse subjects in the whole range of medical science. I shall not allude to the members of my own profession who have chosen so far to forget what is due to their own dignity and the dignity of their calling as to select such an arena for the dis- semination of their fatal errors. As the times are as pregnant with mischief, as the air is with the disease, I proceed to ask and to answer questions asked and answered a thousand times : I St. Does vaccination confer a certain degree of protection against small-pox ? 2nd. Are the effects of vaccination permanent ? 3rd. Is there risk of lighting up local and inflammatory action ? 4th. Is there risk, when vaccinating, of inoculating the system with scrofula, or other hereditary disease .'' 5th. Is there risk of contaminating the system with syphilis, or other acquired disease ? The answer to these questions will, I think, cover the ground gone over by the anti-vaccimtors. 1st. A simple assertion that vaccination does confer a certain degree of protection against an attack of small-pox would at om the fact criment and :hen, as his low ; for no and having the shadow the critical IS a nnodel. :a.ngue in a who may, ;ed as such uneducated ifificult and science. I 1 who have lity and the or the dis- ,s pregnant to ask and imes : protection flammatory dating the 1 syphilis, the ground ;r a certain : would at once be met by a counter assertion that it does not. 'I'he (pies- tion, therefore, will be answered inferentially, and from sources the most trustworthy, though a desire to economize space prevents me from citing at length. And first for England. In the first thirty years of the last century, when inoculation of small-pox was unknown, the nnjitality in London from that disease was 7.4, and at the close it was 9.5 per cent., inoculation having been introduced in the interval. A committee of the Epidemiological Society have (om piled tables to show the ratio of mortality from small-jjox in London before and since vaccination was intro- duced, and the following are the results :— For the fifty yenrs, from 1750 to 1800, the average number of deaths from small-pox out of every 1,000 deaths from all causes was 96 or nearly ten per cent., while during the first half of the present century (the half c^w\.\\^s succeeding the introduction of vaccina- tion) the mortality was 39. In England, according to official returns, tlie estimated death-rate from small-pox alone at the end of the last century was 3,000 per million, while from the same returns the present death-rate from the same cause is only 200 per million ! An analysis of the latter is most interesting. Vaccination has, in Great Britain as elsewhere, had its oppon- ents, but the practice has become more and more general, and the opposition to it less and less, till now it is quite general. What is the result ? During the first ten years of the present century, the mortality from small-pox in every thousand deaths from all causes was 64; in the second decade, 42 ; in the third, 32; in the fourth, 23; and in the fifth decade it was 16. Let the anti-vaccinators explain this as best they may. Not only has the average of deaths from small-pox diminished in the above ratio, but epidemics of the disease have become less frequent. Before vaccination it was as 48 ; during vaccination it was as 14. The inference from all this is thus drawn by Sir Thomas Watson N B; i 6 (tlic ablest iiifdical writer in London) : " Whore vaccination is, the contagion of sniall-])ox need never come." How is it in Wa/cs f Dr. Hughes, of Mold, states, " No child born in the Mold district, and alive at the date of the registration of its birth, has died of small-pox during fourteen years, yet small-pox has prevailed on various occasions all around it." How is it in Irtiand^ where vaccination has been compulsory for the last fifteen years ? The immunity afforded by vaccina- tion there has been such as to induce a wide-spread belief in its efficacy among the people. Vaccination is practiced generally all over that country, and the children of the soil carrying with them an entire confidence in the practice, are always the most willing to be accinated. The results are seen in the following figures, from which ii appears, says an official document, that the Irish physicians have banished small-pox from their island, as Saint Patrick is said to have banished the snakes. In the periods 1830-40, 1840-50, and 1850-60, before vaccination was general, the respective annual average mortalities had been 5,800, 3,827, and 1,272. In the years 1864, 5, 6, 7, 8, they were 854, 347, 187, 20 and 19, respectively. In the first half of 1869, the whole number was three ! The remarkable immunity from small- pox conferred by vaccination, induced a laxity in the practice, , and a few cases occurred subsequently to 1869, but they were Supposed to have been imported. In Montreal there are com- paratively few children of Irish parentage unvaccinated, and our tables of mortality — to which I beg to refer — show how very few of that nationality die of small-pox. What is thought in Scotland of the protective influence of vaccination .' I quote again only our medical teachers — those from whom we are content to receive our medical knowledge. One of the most distinguished medical philosophers that Scot- land — and Scotland is prolific in medical philosophers — has pro- t-«-ination is, states, " No tlate of the "g fourteen -casions all compulsory >y vaccina- >elief in its generally rrying with the most following >"ent, that eir island, In the nation was 'een 5,800, were 854, 1^69, the om small- practice, , :hey were ire com- . and our very ft;w lence of 5 — those )wledge. It Scot- las pro- f duccd ; and one who graced, for a great nuinl)er of years, the chair ol" nu-dicine in the University of Edinburgh, writes thus: — " 'The lirst (juestion is whether or not we have, at this time, in the matter of cow-pox, a power at our command capable, if duly employed, of depriving the poison of small-pox of all fatal in- fluence owv an immense majority of mankind. And on this subject there has been quite sufficient information collected, since tlie date of the papers which were held decisive of the question fifty years ago, to show that the same inference is still inevitable, and that he who disputes it is e(iually unreasonable as he wiu) ojiposes, in like manner, any proposition in pjuclid. Of course, when 1 say there has been amjjle evidence to decide this cpiestion statistically,! mean to . fer to cases where we have not only the negative evidence of large numbers of persons duly vaccinated, having been su'/ equcntly, m'.st of them re- peatedly, or for a long time tog;'ther, expos;:d to the contagion of Siiiall-pux — /. c, pla':ed in the same circumstances in v/hich unvaccinated people have been generally affected, and many of them died of small-pox ; these vaccinated persons have never- theless escaped, most of them witliout any indicaiio" of disease. To r.how that this is the light in which I have always regarded such collections of facts, I quote one sentence from my own lec- tures, written as long ago as 1820-1821, and repeated almost every winter since then : — " You will remember that the question is, not how many vaccinated persons never take small-pox, but how many vaccinated persons are fully exposed to the contagion of small-pox and escape without any disease ; and our assertion is that, so far as is yet known, absolute protection of the human constitution is the rule, and the occcurrence of any disease is the exception." Those who have had the advantage, as I have had, of listening to that most profoundly logical and conscien- tious medical teacher well know the care and thought he gave to his every utterance. Dr. Alison has passed away, and what says 1 > 8 Dr. Hughes Bennett, his successor in the professorial chair ? — "•We have no remedy 'for small-pox) but vaccination," Let us now proceed to the Continent^ and what do we find »* In Copenhagen the fatality from small-pox is but an eleventh part of what it was before the introduction of vaccination ; " in Sweden it is a little over one-thirteenth ; in Berlin, in Prussia, and in large parts of Austria, but a twentieth ; in Westphalia but a twenty-fifth ! ! " In Bohemia, Moravia, and Silesia it has been reduced from 4,000 in every million of deaths to 200 per million. Not only is it satisfactorily established that vaccination is an effectual safeguard against small-pox, it is, according to some, more effectual in preventing small-pox than is small-pox itself. This was thoroughly tested in Hanover, where it was found that out of a hundred soldiers re-vaccinated, sixty-two per cent failed altogether in producing a vaccine vesicle ; and twenty-seven per cent were only partially successful. Soldiers who had already had small-pox were operated upon in the same way, and with precisely the same result. Such information as I could glean from different sources leads me to the conclusion that an attack of small-pox and vaccination confer the same degree of immunity from an attack of small-pox ; but that subsequent fatal small- pox follows more frequently after small-pox than after vaccination. How is the practice of vaccination regarded in the United States ? Gentlemen, it would be an endless matter to quote the opinion of every medical observer in the adjoining Union, but I shall introduce the substance of everyone's remarks as furnished to the State. Many of the States of the adjoining Union have their State Board of Health, and each Board may be considered to reflect the opinion of the medical minds in the State. The State Board of Health for 187 1 says : — "No amount of disinfectants can cope with this dire disease. The only way to thoroughly drive it from the United States is by a national law, as in England, requiring every parent to duly register his child after 9 rial chair ? — n." do we find ? eleventh part " in Sweden ussia, and in >halia but a it has been per million, lation is an tig to some, 1-pox itself. ' found that cent failed ^'-seven per ad already > and with ould glean t an attack " immunity '^a/ small- iccination. he United • quote the iion, but I furnished iiion have iidered to I'he State nfectants I o roughly w, as in lild after I having been duly vaccinated." The experience of Massachusetts is summed up in the report from which \ quote : that small-pox has appeared here and there, but where it has appeared sporadically it has always been in places where vaccination had been neglected. The town of Holyoke, in the Connecticut valley, was an illustration. One-fifth of all the deaths from small-pox occurring in the whole State took place there. The people in Holyoke had not been vaccinated as elsewhere. Dr. Geo. Darby, of Boston, Secretary of the State Board of Health, summarises for his Board as follows (and his summary receives the sanction of the Board) : Vaccination " invests the human body with an armour which can hardly be penetrated by this subtle poison." A year later (an epidemic of small-pox having passed over the Continent) he writes : " The present epidemic is of such intensity, that it is quite common for persons who have had small-pox in former years to now have it again. Such occurrences have been previously rare. Vaccination, whether from the cow or from the human bod\, " takes ' readily, and re-vaccinations prove abundantly the extraordinary susceptibility to the vaccine disease now prevailing, and never before existing. In view of these facts, with which physicians and intelligent persons, of whatever calling, are now familiar, let us thank God for Jenner's great discovery, without which our homes would be desolated, and our peace and happiness destroyed. The imagination can hardly picture the horror which would to-day pervade Massachusetts, were the present epidemic unchecked by vaccination.' A year later (1874), the epidemic being over, the same authority, and the same Board, report inter alia : " One year ago * * * * we were in the midst of an epidemic of small- pox of extraordinary intensity * * * the protective power of vaccine has been proved beyond all question, and the absolute need oi careful vaccination is equally evident." From September 6th to the close of the year, not a single death from small-pox u pj ::\ !i 10 has been reported to us from the cities of the State." I received the last " State Board of Health " report, a few days ago, an interesting document of nearly four hundred pages, and so completely had vaccine done its work that the report contains no allusion to the dreaded disease. Thankful for the immunity afforded, the reporter from whom I quote writes : " Vaccination needs no defence from us. Nothing, however beneficent, can escape the criticism of the times in which we live. But this criticism of vaccination, often passionate and violent, relates chiefly to points which, however interesting they may be, leave the main question unaffected. Let any one read the history of the ravages of small-pox before Jenner's discovery, and compare them with the mortality of Massachusetts from this cause in the present generation, and ask himself the reason of this change. There can be but one answer. We may speculate about the possibility of the potency of vaccine being exhausted in the human family ; we may be surprised to find that people with good vaccine scars sometimes have small-pox ; we may dispute as much as we please about the average period when re-vaccination may be considered a prudent safeguard; we may even conjecture (what no man has proved) that other diseases than that of the cow may be communicated by humanized vaccine ; we may turn the vaccination question with ingenious skill, so that its many facets shall reflect a multitude of curious lights, and after all we find that we rest in a security against this most horrid pestilence, unknown to former generations. The disease is the same now as then, for we see its effect among barbarous tribes ; but because Dr. Jenner lived and made the greatest of all discoveries in preventive medicine we are almost completely safe." I have quoted from a public document which received the sanction of a learned deliljerative body — and the approval of the Government of the State — the most generally intelligent State in the adjoining Union. What says the Ohio Board of Health ? " While sister 11 I." I received days ago, an Dages, and so )rt contains no the immunity " Vaccination eneficent, can ive. But this iolent, relates may be, leave the history of , and compare is cause in the Df this change, ate about the lusted in the )ple with good spute as much ccination may m conjecture n that of the we may turn that its many )d after all we rid pestilence, he same now ; but because discoveries in afe." I have sanction of a J Government the adjoining ' While sister cities in Ohio have been recently afflicted with small-pox, Cleve- land has enjoyed an exemption far exceeding that of former years. * * * * Our comparative immunity from this loath- some and terrible disease conclusively demonstrates the prevent- ive power of vaccination, and must impress every thoughtful mind with the munificence of the legacy the immortal J enner left the human race." I have purposely quoted at greater length from American than from British authorities, because it has been asserted by a certain few, who have spoken against vaccination at public gatherings in this city, that it was an " English remedy, and that Englishmen had a pride in engrafting their ' beastly * virus on the Christian children of fair Canada " — an assertion reflecting but little credit upon the heads, and less upon the hearts of those who advanced it. But American authority (/uo ad the vaccine question cannot be suspected of partiality. I have singled out no individual writer on the subject, (I might have quoted a thousand American writers in favour of the practice of vaccination) but have confined myself to State documents con- taining the deliberate expressions of deliberative bodies, reflecting the condensed thoughts of the best medical minds in the United States. I turn with little pleasure to this, my own country, and especially to this my own city, and I find anti-vaccination views advocated, and disseminated by a small but ceaselessly active section of medical and legal thought. I find from personal knowledge a deeply rooted prejudice against what the scientific world generally has sanctioned, and I find disease disfigurement, and death following in the wake of those teachings ; teachings to the dissemination of which a portion of the daily press has lent its columns. I readily admit that small-pox has its " periods of dormancy and its periods of activity," and that, " every now and then, at irregular intervals, it overspreads a district or country as an epidemic.'' But why should it press so heavily on this city ; and why should it single out chiefly one nationality ? Why should 12 it pass so lightly over Quebec ? Dr. Russell, President of the College of Physicians and Surgeons, residing there, gives the reason : — "We have very little small-pox here (Quebec). We are all vaccinated." The table prepared by the skilled House Sur- geon of the Marine and Emigrant Hospital, of Quebec, Dr. Catellier, is a crushing and unanswerable argument against the anti-vaccinators. There were 131 cases admitted into the estab- lishment between the months of May, 1874, and July, 1875, and of these the vaccinated numbered 54, one alone died. In 69 cases of unvaccinated patients 32 were discharged cured, but somewhat disfigured, and 37 died. In 8 cases where it was doubtful if vaccination had or had not been performed, 6 were cured and 2 died. These computations afford us the following startling percent- ages, which every man and woman valuing the healthy future of their progeny ought to note carefully. The death rate in vacci- na fed cases, is only 1.8 per cent. ; in ummccinated ^T^.d per cent.; in doubtful cases 25 per cent. Can anything tend to expose and confirm the claims of this practice upon the people better than these dates ? Why does it pass so lightly over Three Rivers 1 Dr. Badeau, the Doyen of the profession there, explains : — " On Jia pas de Picotte ici. On se fait vacciner.'' The same for Toronto. And why does it in Montreal visit most severely those of a particular nationality } We nurse it. In Quebec, Three Rivers and Toronto no one writes against or attacks the principle of vaccination — the only prophylactic for small-pox. That the con- verse is true in Montreal is evident from the circumstance that the mortality is immensely greater among that nationality whose beautiful language has been made to serve as a vehicle for the dissemination of a most fatal error. Dr. Osier — whose every statement has the accuracy of a pathologist — furnishes me with the records of the Small-pox Department of the General Hospital from Dec. 14, 1873, to July 21, 1875, the period during which it la esident of the »ere, gives the ebec). We are 2d House Sur- Quebec, Dr. ^nt against the nto the estab- uly, 1875, and died. In 69 ed cured, but where it was 3rmed, 6 were tling percent- Ithy future of rate in vacci- 3.6 per cent. ; expose and e better than hree Rivers .? explains : — he same for erely those of rhree Rivers principle of 'hat the con- nstance that nality whose liicle for the ^^hose every les me with ral Hospital ig which it was under the charge of Dr. Simpson and himself. Thete wete admitted during that period 261 cases, and there were 73 deaths. But how was that death-rate distributed } In the unvaccinated, 58,8 per cent. ; in the vaccinated, 17.09 percent. We have now two civic hospitals in Montreal for small-pox, one presided over by the Sisters of Providence ; the other by Miss Chambers. What is the experience of these ladies .? I give the question put to the ladies of both establishraerts and their answers: — "Have you noticed ai^y difference between the vaccinated and non-vaccinated inmates of the hospital ?" Sister Nativity states, in French : — " There is no comparison between the effects of small-pox on the vaccinated and non-vaccinated ; the vaccinated, as a rule, are not affected, and when they are, they have it slightly ; the deaths are among the unvaccinated." Miss Chambers' experience is precisely to the same effect. What more convincing evidence than this, coming, as it does, from sources whose trustworthiness is beyond doubt or question. I do not quote from the physicians of the city, who, with a very small exception, have again and again expressed their entire belief in the prophylactic power of vaccine. Volume after volume has been written to establish the power of vaccine, and my table, as I write, is covered with documentary evidence, the magnitude of which alone prevents my introducing it here. Sufficient, however, has been adduced to warrant an answer to the first question in the affirmative, " that vaccination confers a greater or less degree of protection against small-pox.'' 2nd. Are the effects of vaccination permanent ? As a rule the answer may be, yes ; but the exceptions are so numerous that I must admit the partial truth of what is claimed by some writers, " that the protection which vaccination affords against small-pox is only of limited duration." During what time is there absolute immunity ? This varies in different indi- viduals; but 1 have long been of opinion, and that opinion is shared by those who have given attention to the matter, that the manner ■"A IK i 14 in which vaccination has been perfortned in the first instance has much to do with the degree and period of that immunity. Although ten or twelve years are said to be the average period, the thoroughly vaccinated have an immunity of much longer duration. In a very large number of cases, unfortunately, vac- cination is not performed with anything like approximate thoroughness. This has been noticed in the Small-pox Hospital here, where an examination of the arms of the inmates has rarely discovered marks of a true Jennerian vesicle. But if there is doubt as to the continued immunity afforded by vaccination, there can be none when it has been performed a second time. Re-vaccination, when successful, affords entire immunity, and in support of this assertion I shall cite but one proof from among a thousand. It has been an imperative rule for the last thirty-four years at the London Small-pox Hospital tl' xt every nurse and other servant of the Hospital shall, on entering the service, be vaccinated. In their case it is generally re-vaccination ; and it is never afterwards repeated. These nurses live in the closest daily and nightly attendance upon small-pox patients ; and the other servants are constantly exposed to the profuse contagion ; yet in no single instance, during these thirty-four years, has any one of these servants and nurses been affected with small-pox. Surely no stronger proof than this can be imagined, that re- vaccination in the adult is an absolute protection against small- pox, and need not be repeated. Up tq the age of puberty, a child properly vaccinated may be considered safe, — but so many of those vaccinated have cicatrices deficient in number and of a character not strikingly good, that re-vaccination should be re- sorted to where there is more than usual exposure to' small-pox. 1 have instanced the London Small-pox Hospital as evidence of the advantages of re-vaccination, and shall cite from official sources evidence of the immunity conferred by it on some of the continental armies of Europe. In five years, says Seaton, there J first instance hat immunity. varage period, f much longer tunately, vac- : approximate l-pox Hospital ites has rarely 5ut if there is "f vaccination, second time, mnity, and in from among a ast thirty-four :ry nurse and he service, be ation ; and it 1 the closest nts; and the e contagion ; 2ars, has any h small-i)ox. ed, that re- :ainst small- »r puberty, a ^ut so many 5er and of a ould be re- ' small-pox. evidence of om official some of the aton, there 15 occurred in 14,384 re-vaccinated soldiers in Wurtemburg only <7//t' instance of varioloid ; and among 30,000 re -vaccinated per- sons in civil practice only two cases of varioloid (one of which was probably really a case of chicken-pox), though during these years sniall-pox had prevailed in 344 localities, producing 1,674 cases of modified or unmodified small-pox among the not re-vaccin- ated, and in part not vaccinated, population of 363,298 pjrsoni in those places in which it had prevailed. In the Prussian army, since the introduction of systematic re-vaccination in 1834, the cases reported as " varioloid," and still more those called " variola," have been, nearly all of them, among that portion of recruits whose term for re-vaccination had not come, or whose re-vaccinations had not been successful, or who were incubating small-pox when they were re- vaccinated ; in the 20 years which immediately succeeded the adoption of this system there oc- curred altogether but forty deaths from small-pox in this large army — (or an average of two deaths per annum) — only four of the entire forty being in persons who, it is said, had been suc- cessfully re -vaccinated. So also in the Bavarian army, in which there had been compulsory re-vaccination since 1843, there had not, from that date up to the time of a report made by the Minister of War in 1855, been a single case of unmodified small- pox ; and only a very few cases of modified small-pox, without any deaths. While, therefore, I answer the second question in the negative, as to the permanency of primary vaccination, the statistics quoted from official sources, with the almost universal collateral concurrence of medical practitioners, warrant the statement that '' after successful re-vaccination, small-pox, even of the most slight or modified kind, is rarely met with ; and that when post-vaccinal small-pox is met with of a somewhat severe character, it is due to the want of care in the performance of vaccination in the first instance, or to want o|) preparedness in the system when primary vaccination had been performed. From It. 16 Ki' 1---I -'1 llii what has been said, a question of vast moment to adults neces- sarily presents itself. As all those who have been vaccinated but once run more or less risk of contracting the disease, and as it is admitted that re-vaccination renews, or adds to, the security against small-pox, common prudence would suggest the course to be pursued by those who wish to guard against this malady. Although it forms no part of my present subject, yet, as an impression prevails with some that persons exposed to small-pox contagion incur additional risk by being vaccinated, and by hav- ing one d.'sease engrafted on another, it is well to state that such a view is entirely erroneous. If vaccination is performed suffi- ciently early, so that the areola may have time to form, it will prevent small-pox ; if later, it will modify that disease. Mr. March illustrates this rule thus : — " Suppose an unvaccinated person to inhale the germ of variola on a Monday, if he be vaccinated as late as on the following Tuesday, the vaccination will be in time to prevent small-pox from being developed. If it be put oft' till Thursday, the small-pox will appear, but will be modified. If the vaccination be delayed till Friday it will be of no use." Sir John Watson, adds : — " Should the person have been formerly vaccinated, revaccination will be effectual two days later than this, because in revaccinated persons the stage of areola is reached two or three days sooner than in persons vaccinated for the first time." 3rd. — Is there risk of vaccination lighting up local inflam- matory action? When we consider the disposition, the temper- ment, the condition of health, of those vaccinated, and the per- iod of life at which vaccination is usually — and the peiiod of the year at which "t is sometimes — performed, it is a matter of sur- prise that local irritation, or erysipelatous action, is not more frequently lit up. At certain seasons of certain years any abra- sure ot the skin, however slight, even without vaccine lymph, is apt U) cause erysipelatous inflammation. What medical man 17 ilts neces- '^accinated ise, and as Je security the course malady, yet, as an small.pox d by hav- "' that such •med suffi- rm, it will Ir. March person to :cinated as be in time 3ut off till dified. if f no use." ave been days later ' areola is inated for f/ injlam- i temper- the per- >d of the r of sur- lot more ny abra- i^mph, is cal man has not sometimes seen erysipelas to follow a slight bruise, or the scratch of a needle or a thorn ? The accidents of this kind fol- lowing vaccination are very few — not by any means as many as I have seen to follow the pulling of a tooth. Yet who ever ad- vised that an aching tooth should l^e left alone because it had happened sometime, somewhere, and in the hands of some one, that hemorrhage from the tooth socket had taken place ; that erysipelas — fatal erysipelas — had sometimes followed ; or that the bones of the jaw had been splintered? These are the acci- dents — and so rare are they that they should not enter into one's calculations. vSo convinced am I of the safety of vaccination, that I have no hesitation in saying that a vaccinator, who knowi his business, would vaccinate a thousand children with fewer un- pleasant results than a competent dentist would have in extract- ing the same number of teeth. There are, 'tis true, precautions to be taken, just as there are common sense precautions to be used by every one in eating, in drinknig, in travelling. But these occurrences would be nire indeed if vaccinators exercised care and judgment in the selection of the lymph (which should be pure, taken at the proper time, and without admixture either of decayed epithelium or of pus) and in the selection of their subjects (who should be neither too young, too feeble, nor too sickly) ; and with these precautions, severe local inflammation would be rare ijideed. But it is not to be expected that some degree of irritation will not be produced. To prove this, child- ren, vaccinated with the purest lymph, will manifest, during the few days that the pustules are at the highest development, cer- tain febrile disturbances of the general system, during which the temperatvire of the body sometimes reaches 104° F, But in cer- tain constitutions, and in certain states of the atmosphere, and especially when the crust is brittle, and with it there happens to be, either through carelessness or ignorance, decayed epithelium or dried pus, or even the purest lymph with an imclean instru- v'> i% i *v. 18 ment, the constitutional disturbance above alluded to, and wbich was till now within the range of health, assumes a morbid char- acter, and more or less severe local or constitutional disturbance is the result. The third question, therefore, may be answered thus : Moderate local inflammatory action may sometimes be lit up, but the severer forms are, as a rule, due to want of care in the selection of the crust ; inattention to the age or health of the subject ; to carelessness in the use of the scarificator ; or to at- mospheric influences ; or to all combined. 4th — Is there risk 'when vaccinating^of inoculating the system with scrofula^ or other hereditary disease f If my answers to the previous questions were necessarily qualified, this one is not, and I emphatically answer, tio. It would be an utter waste of time to proceed to discuss what has already been disposed of, to the satisfaction of every unprejudiced mind. That vaccination induces scrofula or other new disease is an absurdity, notwith- standing the wonderful tales of a verde de lisle, that " it has caused mental and physical degeneration of the human species, diminishing men's stature, incapacitating them for the fatigues of military service, or even the exercise of dancing." One word as to the first : the tallest, strongest, and heaviest men in Europe, according to Proiessor G. D. Forbes, are the Irish : yet Ireland is one of the most thoroughly vaccinated countries in the world. 5th. — Is there risk when vaccinating^ of inoculating with syphilis or other acquired diseases ? The allega- tion has been made by some in the aflSrmative ; but when we bear in mind the strong " temptations to employ false pre- texts/' it is a matter of surprise that vaccination has not been more generally " pitched upon by persons in search of an apolo- gy for their syphilitic children." For my own part, not only have I never seen a case of invaccination of syphilis, but have never met a medical practitioner who had seen a case, either in his 1 '■!IK to, and which morbid char- il disturbance be answered letimes be lit int of care in health of the or ; or to at- f^ the system y answers to is one is not, tter waste of sposed of, to vaccination ity, notwith- that " it has nan species, 2 fatigues of )ne word as in Europe, yet Ireland ies in the noculating^ he allega- but when f false pre- not been fan apolo- only have have never ther in hit 19 own practice, or in that of another. We all know how the slightest scratch or cut is apt to develop tractable ulceration in a child having latent syphilis, and the ulceration thus produced requires the local and constitutional treatment of a syphilitic sore. A slight scratch, required for vaccination, with the purest lymph, may assume a specific character, but conjugal infidelity, and not the vaccination, is the true cause. That vaccineiymph does not carry with it the syphilitic virus, even in cases of undoubted syphilis, may be fairly inferred from the experiments which have been performed on a large scale on the continent of Europe. With well attested experiments like the above standing on record, we are obliged to doubt whether vaccination {i.e. genu- ine and simple inoculation with vaccine lymph) from however syphilitic a subject can possibly communicate syphilis ; or, at the very least, whether some stage of the vaccine vesicle more ad- vanced than vaccination rules allow to be proper for lymph supply, or some admixture, which fastidious vaccinators never permit, of blood with the vaccine lymph, must not be a condition for such possibility. That some ignorant quacksalver, pretend- ing to vaccinate, but neither knowing the aspects of a vaccine vesicle, nor caring from what sort of body he draws his supposed lymph, may take as his *' healthy source for lymph supply " an infant all maculated or ulcered with syphilitic skin disease, and may from its spots or sores transfer infective material to some victim of his mis-called vaccination, is of course evident; for syphilis does not cease to be syphilis because noodle or knave calls it vaccinia; but facts of this kind cannot in any reasonable sense be counted against vaccination, any more than we should count it a fact against Quinine that some grocer had dispensed Strychnine in mistake for it. Finally, too, I permit myself this general remark : that, in proportion as any alleged fact contra- dicts an otherwise universal experience, the individual witness must be regarded as making larger and larger demands on us for li .■■'■ 30 belief; and that in matters like the present, where sources of fallacy are so abundant, the witness's accuracy of observation requires to be most thoroughly guaranteed. The cases of supposed inoculation of syphilis with the vaccine virus are not many, and an analysis reduces them to very few — and those few are still further reduced by the fact that the grossest ignorance and misconduct were imputed to the vaccin- ators. The few cases that hdve been published in the past seventy years, chiefly from European sources, are utterly insignificant in numbers and importance, and lead us to ask the same question as Mr. Simon : " If our ordinary current vaccination propagates syphilis, where is the syphilis that it propagates ? Who sees it .?" The experience of the department is an entire blank on the subject. For the last ten years we have been in incessant intimate communication with the different parts of England on details of public vaccination, and during these years every one of the about 350 vaccination districts into which England is divided has been visited three or four times by an inspector specially charged with the duty of minutely invest- igating the local practice of vaccination ; yet from this systematic and extremely detailed search for all that has to be said on the subject of vaccination in England, no inspector has ever reported any local accusation or suspicion that a vaccinator had com- municated syphilis. Again, our national vaccine establishment has been in existence for more than 60 years, vaccinating at its own stations every year several thousands of applicants, and transmitting to other stations supplies of lymph, with which every year very many (at present 50 or 60) other thousands are vaccinated, who in their turn, become sources of vaccination to others ; but this vast experience does not, so far as I can ascertain, include knowledge of even one solitary case in which it has been alleged that that the lymph has communicated syphilis. Is it conceivable that these negative experiences could 21 re sources of j( observation th the vaccine to very few — fact that the t> the vaccin- in the i)ast are utterly d us to ask nary current 'hilis that it ? department ^ears we liave ifferent parts during these s into which times by an itely invest- s systematic said on the 'er reported had cora- tablishment lating at its icants, and vith Avhich usands are cination to as I can e in which municated ices could 'V; ■m be adduced if the vaccine lymph of children with latent heredit- ary syphilis were an appreciable danger to the public health ? Thirteen years years ago it devolved upon me (as medical officer of the Board of Health), to make the widest possible enquiries! both of scores of public departments and institutions, and also of many hundreds of individual practitioners, in our own country and on the continent of Europe, with a view to elicit all existing experience on the validity of objections which had been alleged against vaccination ; and on that occasion I, of course, gave great prominence to the point which is here raised. One of the four questions which I circulated was the following : — " Have you any reason to believe that lymph from a true Jennerian vesicle, has ever been a vehicle of syphilitic, scrofulous or other constitu- tional affection to the vaccinated person ; or that unintentional inoculation with some other disease, instead of the proposed vaccination, has occurred in the hands of a duly educated medical practitioner ?" The answers which I received on this, as on each of my other points, from 542 members of my profession, are as regards syphilitic inoculation, only just short of being an absolutely uniform " No." The alleged cases (of inoculation) were thrown into real insignificance by their relation to the main body of testimony. Men of the oldest and largest consulting practice in the United Kingdom, men who were believed to have seen every variety of disease and accident to which the human body is liable, our leaders who had taught medicine and surgery to the mass of the profession, physicians and surgeons of our largest metropolitan and provincial hospitals, in England and Scotland and Ireland, physicians who had specially studied the diseases of infancy, surgeons who had specially studied the ino- culative diseases, pathologists of distinguished insight and learn- ing, — men of all thes2 sorts, scores on scores of them, had never in their experience " had reason to believe or suspect any such occurrence as my question described." In the alphabetical 22 B i series to which I have referred there may be read all the most eminent British names of thirteen years ago, certifying to such negative experiences ; there too may be read that equally negative in Paris had been the vast experience of Chomel and Moreau, Royer, and Ricord, and Rostan, and Velpeau ; equally negative at Vienna that of Hebra and Oppolzer, and Sigmund. And in here recurring to that very remarable mass of testimony, I may repeat the remark which my former review of it sug- gested to me : " Obviously, one at least of two conclusions is inevitable ; either it is that with reprehensible carelessness as to the source of lymph, vaccination (so long as in any sense of the word it is vaccination) cannot be the means of communi- cating any second infection ; or else it is the case that in the world of vaccinators care is almost universally taken to exclude that possibility of danger." To the public, perhaps, it matters little which of these conclusions is true. Though it would be the merest idleness to take again now the sort of formal census of medical opinion which I took thirteen years ago, I may state that ever since that time I have felt it among my strictest duties to be generally watchful and interrogative on the present subject ; all the more so, as the period has been one of extraordinary pathological progress, and especially has brought to light very important new knowledge concerning syphilis ; and I have every reason to believe that a present census of personal experience in this country would give just the same practical results as those which accrued from the former enquiry. Indeed, in a few very important directions I am satisfied myself that it does so. I may mention for instance that the Army Medical Department has, during the last eleven years, had cognizance of 151,316 (adult) vaccinations and re-vaccinations performed on the soldiers and recruits of Her Majesty's service, where from the nature of the case the subjects of the proceedings are per- sons who afterwards permanently remain under medical obser- ' all the most tifying to such [ually negative and Moreau, -lally negative ?mund. And of testimony, -w of it sug- ' conclusions irelessness as any sense of of communi- ' that in the 1 to exclude s, it matters ;h it would ft of formal y^ears ago, I among my ative on the 3een one of »as brought philis; and of personal e practical y. Indeed, self that it ly Medical jnizance of formed on here from 5 are per- cal obser- 23 vation, and in whom, therefore, no syphilitic consequences of vaccination could possiblv escape notice ; where, moreover, the chances of latent constitutional syphilis in subjects furnishing the lymph must be about the same as among our civil popula- tion, but in all this vast and critical experience, so far as is known to Dr. Balfour (the eminent and laborious reporter on the diseases of the British army) no single case has ever been al- leged of a soldier syphilized by vaccination. Indisputable cer- tainties, which any one can verify for himself, are : — First, that year by year millions ot vaccinations are performed in Europe with scarcely a solitary accusation transpiring that syphilis has been communicated by any of them ; and secondly, that physi- cians and surgeons who could not fail to see such cases in abun- dance, if such abundance were a reality, concur with an almost absolute uniformity, hundreds of them together, in declaring that they have never in their experience seen even a single case of the kind. One terse observation from the Board of Health Report of Ohio, and I have done : " fV/ie/i properly vaccinated by an intelligent physician, no disease can be produced by inoculation other than vaccinia, the one to be desired." Surely, for every practical purpose, certainties like these are our best guides, and with such certainties in our know- ledge it would be the merest pedantry to insist on infinitesimal speculative uncertainties. It may be some satisfaction to the learned and laborious writers, from whom I have quoted above, to learn that their views are fully' coincided in by most of the lead- ing minds of the profession in Montreal. On Friday of last week I submitted the following questions to the members of the Medico-Chirurgical Society of this city. Doctors are said to differ, and knowing, as I do, the difference of opinion of the members, on almost every medical subject, the unanimity of opinion on the following was most noteworthy. The meeting was an unusually large one, and the Secretary (Dr. Bell) has 24 kindly furnished me with the accompanying minntet with the permission of the Society for its publication : Moved by Dr. Kingston, seconded by Dr. R. P. Howard. — ist. That vaccination confers a certain degree of immunity from small-pox, by either preventing or modifying that disease. 2nd. That that immunity is not always permanent, but may be rendered so by re-vaccination. 3rd. That vaccination may produce in some instances a certain degree of inflammatory action, which may be modified, increased or diminished by the age, constitution or condition of the patient, or by the state of the atmosphere. 4th. That vaccination does not, in any instance, produce scrofula or other hereditary diseases. 5th. That neither the evidence hitherto furnished, nor the experience of the members of this Society, is of a character to lead to the con- clusion that syphilis is ever inoculated with vaccine lymph. Carried. Members of the Medico-Chirurgical Society, present at the meeting on the 13th of October, 1876, all of whom supported the above resolutions : — Drs. T. J. Alloway, Wm. E. Bessey, John Bell, A. A. Browne, G. E. Fenwick, Wm. Fuller, R. E. Godfrey, R. T. Godfrey, Wm. H. Kingston, R. P. Howard, H. Howard, Wm. H. Mondelet, J. B. McConnell, Wolfred Nelson, Wm. Osier, Jos Perrigo, Alex. Proudfoot, John Reddy, Thos. G. Roddick, Geo. Ross, G. B. Schmidt, F. J. Shepherd, E. 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